I understand the question, and it’s mostly conservatives who ask it: Why do we have to replace the Unaffordable Care Act at all? We can’t we just repeal it and be done? After all, if the UCA represented a big-government takeover of health care (which it did), why would we want to replace it with another one?
Just repeal. Forget about replacing it. That’s the argument.
Philosophically, it’s a very appealing argument. But there are two gigantic problems with it. The first is that big government’s intrusion into health care didn’t start with the UCA. It started decades earlier.
Some trace this back to World War II, when the federal government froze wages, but permitted businesses to offer health care benefits as a way to alleviate the effects of the wage freeze, and allowed these benefits to be tax-free. If you’ve ever wondered why so many people get health insurance through their employers, this is why. The tax code makes it easier for your boss to provide your health coverage than it is for you to buy it on your own.
For the most part, this has not been a positive thing. It’s added to the cost of health care by discouraging consumers from being cost-conscious, and by adding massive bureaucracies in the form of third-party payer organizations. Most people spend far more on health premiums than they would if they just paid their own doctor bills. And you can tell yourself all you want that your boss pays the premium, but that’s part of the cost of employing you. One way or the other, it comes out of your pocket.
And even before the UCA, it was illegal to buy health insurance across state lines, which limits choice and makes it harder to shop for the most cost-effective option. Also, the UCA didn’t create the massive jury awards that jacked up the costs of physician malpractice insurance. And guess who ultimately pays for that? You do. Because health insurers pick up the tab for higher service costs and your premiums reflect that.
The fact is that we needed health care reform before the UCA. The problem with the UCA was that it reformed health care in the wrong direction. It doubled down on the worst elements of the system and didn’t fix any of the existing problems. If the GOP had passed a health reform bill during the Bush years, like many of us wanted it to, it might have emphasized the purchasing power of individual patients, de-emphasized the role of third-party payers, limited malpractice awards and gotten rid of restrictions on where and from whom you can buy insurance.
Instead, they punted on the issue and gave the 44th president the chance to do it his way. We all know the disaster that turned out to be. But health care wasn’t so great before the UCA. In addition to repealing the UCA, the Republicans should also institute the reforms that we needed a decade ago. That’s the replacement.
But as Secretary of Health and Human Services Tom Price said last week, there is another reason you can’t just repeal without replacing: People will get hurt if you do. That’s because the UCA laid waste to the parts of the old system that were good. Many of them don’t even exist anymore.
Remember the promise that if you liked your plan you could keep your plan? And how it turned out to be a lie because the UCA made it impossible for your own plan to still exist? Well, it still doesn’t exist. It’s not there for you to go back to. Plans are gone. Networks have narrowed. And don’t forget, a lot of people lost their jobs because companies needed to get under the 50-employee threshold in order to avoid the mandate that they provide health insurance.
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The UCA laid all that to waste. The world of before is gone. So you can’t just repeal the UCA and say, there, everything is like it was before. No it’s not. And as much as we conservatives don’t like the idea of more people being dependent on government, it would hardly be fair to people who got on expanded Medicaid to just kick them off and provide no path whatsoever to an alternative. The federal government created this mess. The federal government under new and better leadership needs to fix it.
There is work that needs to be done to make the bill better. But those complaining about its flaws need to stop complaining and start joining the work that seeks those solutions. It’s hard cleaning up a mess, and there will likely be problems with the fixes. But that’s no excuse not to do it.
And there’s no sense pretending we can just to back to a world that doesn’t exist anymore. We have to deal with the here and now.
