Reality, Unaffordable Care Act

Why not repeal without replacing? Because you can't go back to what's no longer there


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By —— Bio and Archives March 19, 2017

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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.

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