Favorite

GOP gets PR boost with Obamacare reprieve 

The Obama administration's decision to give big employers another year before they are taxed for not providing health insurance for their workers looked like the opening Republicans had been waiting for. As they had been saying, Obamacare just doesn't work and now the administration is admitting it.

But it hasn't gone down that way. Rather than call for the repeal of Obamacare or at least its employer mandate, business groups praised the administration for giving the relative handful of large employers who don't already provide insurance (about one in 20 in Arkansas) more time to figure out the complicated system of rewards and penalties in the Affordable Care Act and decide if they will insure their workers or pay the penalty.

It was, to be sure, an embarrassment for the administration because it was at least a recognition of the immense complexity of the law, a necessity when the president and Congress decided that the only politically conceivable way to achieve universal coverage and some measure of reform and cost control was to try to perfect the Rube Goldberg system of employer-based insurance that emerged in World War II and afterward. It also will give the Health and Human Services Department more time to develop the insurance markets for individuals and employers and perfect the regulations.

The year's delay also provides encouragement, if any were needed, for the Republican House of Representatives to continue the charade of voting regularly to repeal the Affordable Care Act. The reform remains fairly unpopular, the negatives consisting of people who do not believe the government should guarantee access to medical care for people who cannot afford the care or the insurance, people who believe (correctly in my view) that a government program like Medicare would have been much superior to patching the employer-based private insurance system, and people who already are insured and believe the propaganda that their coverage might be affected. (It will be in many instances. Their insurers can no longer cap their medical reimbursement during the year or over a lifetime or curtail their coverage or increase their premiums for a lingering health condition.)

Still, it's the best PR for the Republicans. The worst thing that could happen would be to succeed and actually repeal Obamacare. Suddenly, Medicare recipients, who opposed the reform because they were led to believe by advertisements in 2010 that it would cut their benefits, would suddenly lose benefits and see their prescription drug expenses rise. Hospitals, doctors (especially family doctors) and other providers would lose the prospect of ending charity care. Millions of low-income working families would lose coverage. Millions of people who had lost coverage owing to pre-existing conditions would lose it again.

Ross Douthat, part of The New York Times's stable of "civil" and "thoughtful" conservative columnists, saw the administration's mandate delay as an affirmation for liberals and conservatives alike who have long recognized that the system of employer-based health insurance is what is wrong with health care in America, responsible for the roaring cost of health care and a shortage of competitiveness in U. S. industry. There was some truth in his analysis, but how would he replace it? Somebody else's problem.

Obamacare is a political arrangement, perhaps the best Congress could concoct in the political environment of 2010 or of anytime the past 20 years — or the next 20. "Medicare for all" ceased to be an option as a replacement for a private insurance industry that had become one of the most powerful players in the country. Obama, like all his party's candidates for president in 2008, concluded that the only route was to broaden private insurance coverage by mandating for individuals who didn't have employment coverage but without undermining employment insurance. Without an employer mandate (for those with 50 or more full-time workers), the individual mandate and government premium assistance would encourage big employers to pull back their coverage. Congress thus constructed a complex network of thresholds, penalties and reporting to make that work.

But soaring medical costs in the United States — far and away the highest in the world — and terrible distortions in the health-care system are not the work of employment-based insurance but rather of the reimbursement system for government and private insurance, which has been run by an adjunct of the American Medical Association since the days of the Reagan administration.

You haven't heard of it — the Specialty Society Relative Scale Update Committee, known as the RUC. A committee of medical specialists each year determines the relative reimbursement rates for some 9,000 medical procedures, based on a number of factors, so that an office visit with family doctors and pediatricians is around the bottom and complex surgeries at the top and far away. Washington Monthly has a superb article about the cartel this month.

You want to be a doctor? Get a specialty. The rewards are far greater. So, we have a huge shortage of general practitioners.

The reimbursement and the fee-for-service systems together have stimulated the growth of needless medical procedures, overall health-care costs and premiums.

Obamacare didn't address either of those problems, which is why the AMA endorsed it, but it actually will tackle them obliquely. Congress probably will not let it occur, but the law creates an advisory panel that could recommend lower reimbursement, or none at all, for needless or unworkable procedures. It gives a boost to family doctors. And it deftly suggests that states or programs might try something else besides fee for service, such as bundled care, to see if it works. Arkansas, of all places, is trying it, so far with great success, but no one has dared admit that it is Obamacare.

Favorite

From the ArkTimes store

Comments

Subscribe to this thread:

Add a comment

More by Ernest Dumas

  • Trusting

    It is a Fourth of July ritual to appraise where we are in meeting the Declaration of Independence's promise to institute a government that would, unlike King George, secure human rights equally for everyone who sets foot on American soil.
    • Jul 6, 2017
  • Obamascare

    Republicans at long last may be about to see their most fervent wishes and wildest predictions materialize — millions of people losing their medical and hospital coverage, unaffordable insurance, lost jobs, a Medicare financial crisis, mushrooming federal budget deficits and fiscal crises across state governments.
    • Jun 22, 2017
  • Ethics upended

    Every week, Donald Trump finds another way to upend conventional ethics in government and politics. Here's one that has been in the making since the campaign but is reaching maturity in the Russian investigation: He is turning the heroes of government scandals into the villains.
    • Jun 15, 2017
  • More »

Readers also liked…

  • AEC dumps ALEC

    No matter which side of the battle over global warming you're on, that was blockbuster news last week. No, not the signing of the climate-change treaty that commits all of Earth's 195 nations to lowering their greenhouse-gas emissions and slowing the heating of the planet, but American Electric Power's announcement that it would no longer underwrite efforts to block renewable energy or federal smokestack controls in the United States.
    • Dec 17, 2015
  • No tax help for Trump

    The big conundrum is supposed to be why Donald Trump does so well among white working-class people, particularly men, who do not have a college education.
    • Aug 11, 2016
  • Dollars and degrees

    Governor Hutchinson says a high graduation rate (ours is about the lowest) and a larger quotient of college graduates in the population are critical to economic development. Every few months there is another, but old, key to unlocking growth.
    • Aug 25, 2016

Most Shared

  • So much for a school settlement in Pulaski County

    The Arkansas Democrat-Gazette's Cynthia Howell got the scoop on what appears to be coming upheaval in the Pulaski County School District along with the likely end of any chance of a speedy resolution of school desegregation issues in Pulaski County.
  • Riverfest calls it quits

    The board of directors of Riverfest, Arkansas's largest and longest running music festival, announced today that the festival will no longer be held. Riverfest celebrated itsĀ 40th anniversary in June. A press release blamed competition from other festivals and the rising cost of performers fees for the decision.
  • Football for UA Little Rock

    Andrew Rogerson, the new chancellor at UA Little Rock, has decided to study the cost of starting a major college football team on campus (plus a marching band). Technically, it would be a revival of football, dropped more than 60 years ago when the school was a junior college.
  • Turn to baseball

    When the world threatens to get you down, there is always baseball — an absorbing refuge, an alternate reality entirely unto itself.

Latest in Ernest Dumas

  • The ACA can be fixed

    Majority Leader Mitch McConnell threatened his 51 disciples in the Senate and his party with the gravest injury imaginable.
    • Jul 13, 2017
  • Trusting

    It is a Fourth of July ritual to appraise where we are in meeting the Declaration of Independence's promise to institute a government that would, unlike King George, secure human rights equally for everyone who sets foot on American soil.
    • Jul 6, 2017
  • Obamascare

    Republicans at long last may be about to see their most fervent wishes and wildest predictions materialize — millions of people losing their medical and hospital coverage, unaffordable insurance, lost jobs, a Medicare financial crisis, mushrooming federal budget deficits and fiscal crises across state governments.
    • Jun 22, 2017
  • More »

Event Calendar

« »

July

S M T W T F S
  1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31  

Most Viewed

  • Another Jesus

    If you follow the logic of Jason Rapert and his supporters, God is very pleased so many have donated money to rebuild a giant stone slab with some rules on it. A few minutes on Rapert's Facebook page (if he hasn't blocked you yet) also shows his supporters believe that Jesus wants us to lock up more people in prison, close our borders to those in need and let poor Americans fend for themselves for food and health care.
  • Pay attention

    If anyone thinks that a crisis with the Power Ultra Lounge shooting, then he hasn't been paying attention to Little Rock.

Most Recent Comments

  • Re: Another Jesus

    • The prophet Isaiah was a man of unclean lips and dwell among people of the…

    • on July 21, 2017
  • Re: Turn to baseball

    • leave the rules the way they are. teach players how to hit, don't legislate no…

    • on July 20, 2017
  • Re: Pay attention

    • The beautiful new 12th St. Precinct is full of empty rooms: Why not create a…

    • on July 20, 2017
 

© 2017 Arkansas Times | 201 East Markham, Suite 200, Little Rock, AR 72201
Powered by Foundation