I’ve never been the biggest fan of the Patient Protection and Affordable Care Act (aka “Obamacare”). It’s not perfect. It’s too complicated. The cost containment mechanisms built into the health care exchanges haven’t lived up to expectations. The Supreme Court ruled that states had a right to turn down the Medicaid expansion that provides affordable health insurance to the working poor and a staggering 19 states (including the second and fourth biggest by population) did so.
Overall, the U.S. health care system is still the most expensive in the world and still leaves almost 10 percent of the population uninsured, a higher portion than other major industrialized nations.
President Obama himself favored the much simpler approach, single-payer, earlier in his career. But, as president and faced with the question of what kind of program he could push through Congress (that rules out single-payer because of the power of the private health insurance lobby) without any Republican votes (not because he didn’t want Republican support but because Republicans decided to just say no) the Affordable Care Act was what he was able to sign into law, and that just barely.
Because he needed 60 votes in the Senate and there were exactly 60 Democrats, he ended up having to negotiate with the most conservative Dem senators and settle for whatever he could get them to buy, and then throw in a couple of specific sweeteners for the last holdouts that gave the whole process an odd smell. Republicans were mostly opposed from the get-go and pounded the few wobbliest Republican senators into submission. In the end, they all voted nay.
The program has done a lot of good. The single best measure of that good is that the portion of Americans who are uninsured has fallen by slightly more than half, from about 20 percent to a little under 10 percent, which is an all-time low for our country (but, as I said above, still high by wealthy-nation standards. Many of our overall health outcomes are also still poor by comparison. Athough that fact probably has a number of interlocking explanations, lack of insurance coverage for almost 30 million Americans is a big factor.)
The cynical (or perhaps just misguided) decision of those 19 red states to turn down the Medicaid expansion is a big factor. If I try really hard, I can see that decision as an act of principle. But, if that’s what it is, it is an act that puts the principle of restraining the growth of government ahead of the powerful human need of working-poor families in those states to have access to basic health care. And if it is that, it was an act of principle that required no sacrifice, no compassion and no political courage by those who made it.
The Republican campaign of vilification of the law has been powerful and effective. They focus on problems with the program, exaggerate those, and never bring up the important gains, such as the halving of the uninsured rate. In a culture more steeped in intellectual honesty, this would render such criticism laughable. But in the polarized and partisanized U.S. political environment, they got away with it. As a certain president-elect might tweet: “Sad.”
At a certain point, once they had the votes in Congress to do it, the Republicans started routinely voting to repeal the law, knowing Obama would veto the repeals. They did this more than 60 times, which, to me, is a sad comment on how they chose to use their time and their majority. In criticizing Obamacare, Republicans like to point out that none of them voted for it, as if the law was crammed down their throats, but that overlooks the lengths to which Obama and congressional leaders went to make it a bipartisan process.
But now it’s different. The next time the Republicans repeal the ACA, it will be repealed, and that will be quite soon.
At some point, the Republicans adopted the slogan “repeal and replace.” The general idea was that their replacement would cost less and do more good for the health of Americans. But, as you probably know, they never produced an actual bill to create an actual program that could be actually scored by neutral experts to determine whether the not-really-existent replacement program would indeed do more good at less cost.
It’s kind of amazing – one might even call it shameful – that, if they have a such a plan, they have never put it on the table. Or perhaps there is no such plan. Because Republicans have been so careful never to take note of the reduction in the uninsured numbers under Obamacare, I am quite concerned that they don’t consider this to be an important measure of the benefits of national health care system.
Donald Trump has also been an Obamacare basher and has been somewhat incoherent on health policy in general. If we go back a way, he seemed to favor Canadian style single-payer. If that surprises you, here is a quote from his year 2000 book “The America We deserve:”
We must have universal healthcare. … I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses. …
Doctors might be paid less than they are now, as is the case in Canada, but they would be able to treat more patients because of the reduction in their paperwork..
The Canadian plan also helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. If the program were in place in Massachusetts in 1999 it would have reduced administrative costs by $2.5 million. We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.
That may have been his ghostwriter’s opinion, but can we assume that Trump at least read it before it was published under his name?
And if that’s ancient history, here are words that actually came out of his mouth during the 2016 campaign, such as, in a September (2016!) interview with Scott Pelley on “60 Minutes”:
TRUMP: “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private. But —’ ”
PELLEY: “Universal health care.”
TRUMP: “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”
PELLEY: “The uninsured person is going to be taken care of. How? How?”
TRUMP: “They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably —”
PELLEY: “Make a deal? Who pays for it?”
TRUMP: “— the government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”
It’s fairly amazing that this didn’t cause a bigger stir at the time – September of 2016, after he was the nominee. Somehow or other, it qualifies under the (to me) absurd notion that Trump’s supporters took him “seriously, but not literally.” If we took him literally, he will be a proven liar and promise-breaker if it turns out that he does not produce a health care system that takes care of “everybody” and the government “pays for it.” That’s what he promised.
It sounds far-fetched. But yesterday, Trump said to the Washington Post just this past weekend something fairly similar to what he said to “60 Minutes.” It led to this lede on a piece that ran in today’s edition of the Post:
President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of ‘insurance for everybody,’ while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid. Trump declined to reveal specifics in the telephone interview.
I have no idea how seriously to take this, and if it is more true than false it will be extremely interesting to see how much Republican support he can attract for it. If it turns out to be serious, it will be a big moment in the emerging understanding of the Trump presidency.
But suppose he doesn’t keep that promise literally of “insurance for everybody” but only signs up for a replacement for “Obamacare” that meets Obama’s own criteria for what he would call a successful version of Trumpcare.
In his farewell speech last week, Pres. Obama said:
If anyone can put together a plan that is demonstrably better than the improvements we’ve made to our health care system and that covers as many people at less cost, I will publicly support it.
The audience applauded. Personally, I’m prepared to take Obama at his word. And I feel the same way. Show me a plan that will provide health care to more people at less cost with at least roughly equal coverage and I will both eat my hat and greatly rethink my fears about what the next four or more years are going to be like for at least lower working-class Americans.
But my big fear is that the combination of Donald Trump and the Republicans who now control both houses of Congress will not put me to that test. I hope I’m wrong.
It’s easier to promise
than to deliver.
Undeliverable promises of incompatible outcomes have been Trump’s stock in trade.
‘Fool me once, shame on you. Fool me twice …. ‘
“Fool me once . . .
” . . . fool me once, shame on — shame on you. Fool me — you can’t get fooled again.”
–George W. Bush (and The Who)
“Repeal and Replace”
According to an article in this morning’s Times, “repeal and replace” became the Republican slogan in March of 2010, before the Affordable Care Act had even passed. Of course, nearly seven years on, they have yet to come up with a credible plan for replacement, but by golly, they sure have a catchy slogan!
Almost all of what Trump says are “aspirational” statements or negotiating positions.
And people look for the details that lie behind the statement and come up empty-handed because there generally is no there there.
Whether his statements indicate any final concrete form of what he is talking about is an entirely separate thing.
But here we are, talking enthusiastically about the possibility of health-care for all.
If:
We get it, then we have seen a republican party that has “changed its spots” on health care, I hope they do it. Basically single payer/negotiator. 180 degrees from where they were during the Obamacare discussions.
High risk individuals
As I understand it, the key to Republican health insurance policy is to put high risk individuals in a pool and subsidize their care. In terms of Republican thinking, I don’t necessarily understand why this has a lot of appeal for them. It violates a number of basic principles for them; it’s not a market based solution for one thing. It’s pretty expensive for another. But they do know that they won’t get a lot of push back from Democrats for violating internal Republican thinking. And it does give them the appearance at least of keeping their promise they have made to the American people generally, that they will provide cheap insurance for preexisting conditions. Now the fact is, the implementation of this plan is highly problematic, but the cynic in me believes that Republican really don’t want to implement it, and that they will blame the failure to do so on Democrats.
If True
That means there is no diversified insurance pool to draw from. Suggests that all the high riski will be paying high risk rates, (no subsidies) more or less indicates UN-affordable insurance. At least the “R’s” can maybe use this as a way to shed the “Death Panel” label!
High risk pool
It can mean that, certainly. Something I warn against, Cassandra-like, is any measure that requires congressional follow up to succeed. Congress is very bad at follow up.
The high risk pools were never sufficiently funded preciously, they won’t be finding them sufficiently in the future, and as “welfare” programs, they’ll be even easier targets for budget reductions.
Two sentences…
“…If it turns out to be serious, it will be a big moment in the emerging understanding of the Trump presidency.”
Absolutely!! If it turns out to be serious, the Republican President will – in a very public way – be diametrically opposed to the Republican Congressional leadership and establishment. It’ll be VERY interesting to see how his purported political allies respond – if it turns out to be serious.
“…But my big fear is that the combination of Donald Trump and the Republicans who now control both houses of Congress will not put me to that test. I hope I’m wrong.”
I hope Eric is wrong, too, but I’m not going to hold my breath. Neither Mr. Ryan nor Mr. McConnell have provided any evidence that this ordinary citizen can see which provides a basis for optimism.
keeping up with the Putins
Even Russia, at least on paper, has mandated universal health care.
Eric’s usual double standard
Eric writes about Trump: If we took him literally, he will be a proven liar and promise-breaker if it turns out that he does not produce a health care system that takes care of “everybody” and the government “pays for it.” That’s what he promised.
Why is Eric now worrying about a politician who lies about health care legislation?
Point 1: “You can keep your doctor and save $2,500 annually.” President Obama.(Too many times to count.)
Point 2: A Nov. 10, 2014 Forbes’ news report): new video surfaced in which (ObamaCare architect Jonathan) Gruber said that “the stupidity of the American voter” made it important for him and Democrats to hide ObamaCare’s true costs from the public. “That was really, really critical for the thing to pass.”
If Trump does indeed tell lies to get health care legislation passed, how is he different from Obama?
Point 3: In 2010 when Republican Eric Cantor gave Obama a list of proposals for the ACA bill the new president said he would consider the GOP ideas (but never did) infamously adding “because elections have consequences.”
Trump is too much of a gentleman to express that kind of arrogance, but Obama set the precedent if our new leader does follow that course.
If Eric had included those facts, his column today might have had a speck of persuasion.
Thank you! Thank you!
“…Trump is too much of a gentleman to express that kind of arrogance…” provided me with the best laugh I’ve had in quite a while.
Broken promises versus lies
Eric I think is discussing “false promises” which are lies and which I think most of us distinguish from “broken promises”. The difference between them being in the promisor’s true intent at the time the promise is made. A promise can only be false and a lie if the promisor has no intention of delivering on the promise at the time it’s made, so that it’s ” with their fingers crossed behind their back” so-to-speak or with no present intention of ever acting on the promise. President Obama’s promise about health insurance might be a broken promise but it was never a false promise. Just like he promised “universal” health insurance” in his campaign and then found out politically it was undoable after he was elected. The same thing with the costs. I think you’d find at least in Minnesota, you were able to find a plan and keep yopu doctor. As it happened, you might not be able to afford it. Anyway, Obama was speaking to the critics who were trying to confuse the issue by claiming you’d be forced the change doctors, which the ACA never did. And whatever Gruber, a consultant, said about foling the American public, is not attributable to Obama. Anyway, I don’t think his comments disprove what the Congressional Budget office has determined that the ACA is reducing the cost of health care and the deficit.
About Eric Kantor: The comment you refer to was actually mentioned by Eric Kantor in his opinion piece published yesterday in the NY Times. But he quotes Obama as saying “elections have consequences” in response to the Republican Plan for a stimulus package in early 2009, not the ACA. According to Kantor “the centerpiece of our plan was a 20 percent reduction in taxes for small businesses.” That was it.This after republican policies over the prior 8 years had rune the country into this ditch. This was at a moment when the country was dangling over the abyss of a potential Depression that echoed the Great depression of the 1930’s. When the President proceeded to pursue the still relatively modest plan (which many leading Keynesians felt was too timid) the Republicans became, if they had not already promised to make Obama a “one term President”, the “party of “no.”
I kept my Dr.
I retired early, in 2009, and was a able to keep my company provided insurance (on my nickel). At that time it was $450 a month. In 2010 they switched everyone to high deductible…by 2014 when ACA went in I was paying $950 a month, with a $3500 deductible. Similar plan on the exchange, with similar coverage, from the same carrier (BCBS) was $550 a month. I kept my Dr…and saved money. On Medicare now…still paying $600 @ mo. (Medicare + Part D + Supp. Plan + private drug plan). And I still have my same Dr.
Insurance companies have fought to control the narrative on health care, eliminating the existence of tens of millions of Americans who are desperately in need of health care. Not just health insurance: a doctor’s and hospital’s CARE. That’s where we should begin our discussion of national policy on not letting our people die without medical attention and treatment.
If we started with the national problem, which is lots of people sick, we would of course come up with a national health care program. Obama began with the problem of the people in need, and with the problems presented to their health care by the health insurance business that controlled it, and tried to carve out improvements that would have a major caveat: We cannot damage the business model of the health insurance industry in order to help people receive health care. That is the nexus of our current difficulties with “Obamacare.”
Republicans begin always with What’s Good for Business, rather than with what’s the problem that we can fix for the average person.
Trump doesn’t impress with his attention span, but he seems to have absorbed one basic issue in national health care policy: Everybody has to be covered for health care, with no exceptions because of “pre-existing” health problems. If Trump also has a basic comprehension of the principles of insurance, and insurance pools, he has to realize that without a mandate that even the healthy buy health care insurance (the “mandate”), the pool skews to the sick. And fails. He and the Republicans have to address that.
Exactly: Problem Solving 101
“If we started with the national problem, which is lots of people sick, we would of course come up with a national health care program.”
I don’t like it at all, find it (mildly) depressing, etc., but one of the things I’ve been forced to agree with about life as a human being is that, as many an expert has explained, one of our primary (and endless) occupations is “problem solving.”
And when a person looks into that idea and, at times, looks around for info and advice on how to do a better, less frustrating job of that, one of the first things a person notices is the experts all seem to agree that Step One is to “Identify the problem” because, until that’s done, the chances are high all efforts will be in vein.
In this case we have one highly influencial group of interested persons saying and saying and saying the problem is finding a way to preserve the status quo of the health care industry (which includes the insurance industry) while “making sure every American has access to the health care they need.”
The predominate Republican thinkers, talkers, political power-wielders and would-be problem solvers have Identified The Problem as being the horse and The Solution as being the preservation of the (jewel-laden) cart.
As many professional problem solvers (and my Grandpa) would say, “Good luck gettin’ that cart through the mud without that horse out ahead of it.”
Or, put another way, it’s unlikely as can be that anything anyone comes up with — no matter which political party or plan — will stand a chance of working until the problem gets identified as accurately as you’ve defined it.
For just one small, but prevalent, example of “inaccurate problem identification,” the endless repetition of, “Health insurance rates have gone through the roof under Obamacare,” is a pretty good one.
And, because it doesn’t follow Problem Solving Rule #1, the proposed solution — getting rid of it and replacing it with “something else” — may fulfill a six-year political promise but it won’t do anything to solve the problem; and, unless someone has a secret miracle up their sleeve, will just add more miles of mud to the road.
Price’s Plan
Tom Price’s plan is the only specific alternative that’s been presented. And I use “alternative” in a very broad way.
It doesn’t have the same coverage, doesn’t offer similar “pre-existing condition” protections, relies on pubic subsidies (tax credits, high risk pools) and health savings accounts. Tax credits are not income based. Doesn’t have the same standards for policy coverage and places limits on state’s ability to oversee policies. And hasn’t been scored by the CBO.
It does allow small business and similar associations to pool and purchase coverage as large businesses do – a real benefit.
But I think this will be the model for the eventual Republican alternative. It will do less, for fewer people but will be touted as “better”.
I should add a couple of other things about Price’s plan, which I think we’ll see in any eventual Republican plan.
It calls for establishing “clinical standards” that can be used to defend a physician against lawsuits. In principle a good thing as it should help minimize defensive medicine and nuisance lawsuits.
But it also includes other provisions that clearly favor the physician in any allegation of negligence.
Malpractice/Negligence
Tort law has traditionally been left to the states to decide. Malpractice or negligence claims, in particular, are matters of state law.
So what was that about “states’ rights” again?
And More Than That
States rights has gone the same way as grid lock. The GOP had a long love affair with both, but they’ve both been dumped for a prettier girl.
Look for a push to eliminate the ability of states to set minimum wages higher than the feds.
I don’t think saying that “Republicans decided to just say no” is a true depiction of reality. I may guess that Republicans had reasons to say “no” (for example, one may be that they didn’t have time to read the entire law) which is different from “just saying no.” On the other hand, I may also guess that in order to bring some Republicans on board, Obama should have made some changes to the law and would have lost some Democrats in the process.
Now about the program itself. It looks good on paper that so many more people are insured but the fact remains that for many of them deductibles are unaffordable so they still don’t go to the doctor unless it is an emergency. Nor can most of them afford a premium so the government pays more and more of that thus increasing deficit. And America may be at the bottom of the developed world in the number of uninsured but we are also protecting that entire developed world from Russia and China, and that is not cheap.
I have to admit that I can’t think about real solution for healthcare – it is too complicated. But Cuban and Soviet system is bad, regardless of what Michael Moore wants you to believe, and Western Europe system has its problems as well. The only thing I am sure of is that people who don’t take care of their health should pay for that (for example, smokers should pay a much higher premium than non-smokers and DWI should result in an increase of not only car insurance but health insurance as well ).
Pick Your Poisen
Given that European systems are much, much cheaper and have much, much better outcomes than what I’m often told is “the best healthcare in the world” here in the US, I’d probably take any one of the European systems along with whatever problems it may have. At least we’d have cheaper problems, so we could better afford to repel what you seem to feel is the existential threat we face from China and Russia. (Given our military {not defense} budget is many levels of magnitude greater than theirs, I see no real threat.)
As for Cuba and Russia, I’ve not heard anyone seriously propose we adopt those systems. Not sure if that’s a red herring or a straw man, but in any case bringing them up is no more useful than bringing up the Martian healthcare system. So can we drop Russia and Cuba already?
An objective for “replace”
As T.R. Reid has shown in his two books “Healing America” many orher countries figured out how to take the ‘profit’ out of health care consistent with their value systems. Unfortunately, the insurance, pharmaceutical, and hospital association industries under that quite well and knew exactly what to keep out and what to put in ACA. To get a birds eye view of the ACA creation process and the subsequent rulemaking process I would suggest Steven Brill’s “America’s Bitter Pill.” It could help in what not to do in any ‘replace.’
To cover the pre existing condition folks
just take a fraction of the subsidies paid out by Obamacare put it into a pool and you can cover the people who need it most.. Save billions of tax dollars and still take care of the sickly .. There is still Medicaid for those who need it (ACA just expanded it with plans and subsidies) and for the 26-45 year old working man, he can now get a catastrophic plan for $50 bucks a month that has a $10,000 dollar deductible. Now instead of the Government saying you have to have an $850 dollar a month/$10,000 deductible plan (remember tax payer pays $9,600 of the total bill of $10,200 for those who qualify) a young working man can get the same plan for $50 a month!
It can be done with some common sense solutions just as long as the insurance companies, DC elites, academic scholars and lobbyists don’t write it like they did the ACA, things will be fine.
Until
The “working man” gets cancer, has a heart attack, falls down a flight of stairs etc… and finds himself bankrupted by the useless insurance he carries. I wonder, would the right think he’s worthy of assistance then? Of course Medicaid and Medicare are also toast, so your first premise is also flawed. But no matter, we’ll all soon learn the error of the conservative way.
Common Sense Solutions
Great idea! Let’s keep the experts out of it.
By that logic, no farmers, ag lobbyists, or industry representatives should be allowed with a mile of the next farm bill. Things will be fine.
There’s only one option
The health care payment system in the U.S. is the most expensive, most complicated, most bureaucratic, most divisive system in the entire world. ACA didn’t change any of that. In fact, it made it more complicated and more divisive (non-subsidized resent those who get subsidies who resent those on Medicaid)).
Republicans think they won because they promised to repeal Obamacare. But just as Democrats are now considered the out-of-touch party, Republicans are going to prove to us that they are just as out-of-touch. They won’t be able to come up with an improvement because they refuse to acknowledge and accept what worked about Obamacare and what didn’t. They certainly won’t be able to understand that the only true replace option is:
Medicare for anyone not covered by an employer based plan. Medicaid for families up to 400% of poverty. Or Medicaid for anyone not covered by an employer based plan, with premiums on a continuous sliding scale, not a sudden drop off at 136% of FPL and subsidies only between 136% and 400% of FPL.
If Trump ever figures this out and starts pushing this idea, there’s going to be a lot of Republican heads exploding. It might get real messy for lawmakers. Or it might get real disastrous for Americans. Only time will tell.
Trump saying exactly what people want to hear.
According to polls by Kaiser and Pew, the lower the income goes, the more people want government to assume the role as the guarantor of their health care. For Republicans with incomes of less than $ 30 K a year, 52% take that view. There is distrust of HSA’s and the idea of higher deductibles and copays–anything that increase out-of-pocket expenses–is disliked. And those who have just obtained coverage do not want to lose it.
In the end, it is the Trump voters who want “something for nothing”–great.lower-cost, healthcare assured by the US government accompanied by tax cuts.
Hard to square that circle, especially with the Congress that we have and the money centers that make up the medical industry.
Now if one were terribly cynical, one would say that Trump is raising unobtainable goals in order to discredit the legislative process–at some point making the nay-sayers of Congress the enemy of the people, with the only answer being more Trump powers.
“A Great Plan””
PEOTUS Tweety asserts, “But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”
The utter lack of connection with any everyday reality may be a given, but this reminds me of anecdotes (perhaps apocryphal) about Nelson Rockefeller’s cluelessness when it came to “average Americans.” In one case, a wino approached Rocky looking for a handout. “Don’t worry, Fella!” Rocky supposedly said, “We’re going to get you a tax break!” In another case, at a time when average family income was under $7,000, Rocky took a committee to task–“Think about how this will affect average Americans who only make $100,000!”
As F. Scott Fitzgerald observed, “The very rich are different from you and me.”
Seriously
What a damn mess. My 2013 insurance was about $75/mnth with a $2000 deductible, now it’s like $300/mnth and a $6000 deductible. It’s like save me from catastrophe but sucker me into debt servitude by fiat insurance. Dems aren’t honest about what a boondoggle the ACA is, and Repubs seem to want to cull the herd, social darwin like. Trump is our only hope, LOL…MEDICARE FOR ALL AND A NEW FOCUS ON WHOLE SYSTEM HEALTH, AND PERSONAL RESPONSIBLITY
Obama’s Plan
Obama tried too hard to get GOP support for a good conservative health care plan. If more generous subsidies were made available for the ACA, the high deductibles would be lower. The problem was that Obama didn’t want to blow a hole in the budget. He should have done what the GOP does when they are in power: stop worrying about the debt and spend some dough! Like Bush did with the prescription drug benefit.
Now Trump and the new GOP Congress will ladle even more cash on an already bloated military budget and cut taxes on the 1%. Even the Tea party will get it on the act. The GOP shows every time that only suckers worry about the debt. And they’ll do it again.
Mess
This is a pretty radical thing to say, but the fact is, health care policy just isn’t that complicated. You go to the doctor, you get a bill, the bill gets paid. Simple really. Universal insurance goes about 99% of the way toward solving the problem.
The issue has never been the lack of a solution. Rather, the issue is that there are just too many solutions and up until the Obama administration, we were never able to decide on one.
Obama tried too hard to get GOP support for a good conservative health care plan.
President Obama didn’t have the support of Congressional Republicans, but he did have the support of Republican constituencies and that’s what mattered. But the deal he made with them was to be less aggressive on cost, something that aggravated many Democrats, me among them at the time. And the political price we paid for that is visible now. Health care costs are too high, giving Republicans who fiercely opposed cutting them at the time, a very effective campaign issue now. Republicans, no oppose both the high cost of health care, and any meaningful effort to cut those cost, a contradiction we have never even managed to explain let alone exploit politically.
If more generous subsidies were made available for the ACA, the high deductibles would be lower. The problem was that Obama didn’t want to blow a hole in the budget.
The big problem here is that the measures used to push people into heaAlth insurance weren’t coercive enough. But here again, Republicans complained that they were too coercive.
So where does this leave us. President Trump has proposed universal coverage with lower deductibles and lower cost, which is pretty much the program Democrats wanted to deliver, but couldn’t without Republican congressional support.