Devil in the detail

The talking heads, never missing an opportunity to play follow the leader, are thumping again — with John Roberts again becoming Chief Semanticist — for a Republican “alternative to Mr. Obama’s Affordable care”.

That’s exactly what we must not have. There are possibly solutions to many of the problems of American health care [and far too many ill-informed comparisons with other countries’]. But they do not lie in adopting some new, monstrous, unworkable, poorly written, overall solution to a gigantic problem.

Obamacare may be collapsing on its own – and thereby making a massive contribution to those who would reform America’s health system, to pardon the phrase, in a systematic way.

Hawaii’s exchange is the latest to implode of the 13 which chose to have state-run exchanges to provide medical insurance. That’s in spite of $205 million in federal taxpayer funding to set it up and keep it going, a part of the nearly $4.5 billion Washington has thrown at the state exchanges in an effort to save them. Only 37,000 ever enrolled in Hawaii’s exchange – a long way from the estimated 70,000 required to make the website financially viable. Now Hawaii’s legislature refused to toss in another $28 million after not a single person would sign up during the extended enrollment period. It had been an off and on affair in any case with the fund periodically closed down for problems including its website coding.

But that is only the beginning of the national problem. Next month, the Supreme Court was supposed to rule on whether the Obamacare law intended for the subsidy to be paid to individuals insured by state exchanges or only for the federal ones. The opponents of Obamacare argued that was the intent of the law’s drafters and therefore ought to honored. The Obama Administration is argued that it was simply a mistake in the wording of the bill that allows it to be interpreted that way. Chief Justice Roberts argued that he was going to save Obamacare, whatever, even if he had to retranslate the law, apparently to preserve the peace and quiet of The Court for even more momentous decisions later on in what looks like a long tenure.

It was a tough decision for the justices. “Legislative history”, the record of all the debate producing the law, should tell us what was in the minds of the drafters. But since Obamacare was rushed through the Democratic majorities in both Houses at the time, that may not be clear. [Remember, then House Speaker Nancy Pelosi told us we would know what was in the bill once it was passed.]

The argument that it was just a few misplaced words could be true. For the days when the old “Bourbon and branch water” veterans with their long experience drafted legislation on The Hill are long since gone, replaced too often by “the blow-dry boys” [and girls], many from a new class, if highly “credentialed”, rank amateurs who float back and forth between parliamentarians and even party allegiances.

But when the Court ruled for the Administration, however, that would be only the beginning of new troubles. It would encourage those states who did not choose to set up state exchanges to do so in order to grab the subsidies for its participants. But with state exchanges failing, that’s not an easy choice – especially since the feds have run out of money to set up the websites, much less to continue the subsidies.

This mess will have to be sorted out, of course, piece by piece – along with the other real issues of covering non-insured sick Americans and curbing rising medical costs. [Okay, they are down recently – maybe just because with the economic downturn, fewer sick have an option for medical service.]

It is therefore painful to hear the constant drumbeat in the mainstream media and among talking heads on TV bemoaning the fact, they say, that the Republicans don’t have an answer to Obamacare.

The Republicans, they say, ought to come up with a comprehensive solution.
Trying to solve the problems of one sixth of the U.S. economy, perhaps its most complicated for more than any other it involves personal “feelings” in decision-making, was a stupid idea. None of the 365 members of The Congress are endowed with that kind of omnipotence.

The way to solve the problems of American health is to go at them one by one, specifically and with detailed knowledge. Some are easy: wipe out the nice little patsy some insurance companies have with some state legislatures to limit access to within their state. Others such as how to assure a maximum coverage at minimal cost [yes, the U.S. spends much more on breast cancer testing than the Europeans, but look at the difference in mortality rates!]

When we hear “comprehensive”, we reach for our gun, to paraphrase one old Nazi’s threat. So let’s drop it and go to work on specific solutions to specific problems. That has been the American way in the past, a pragmatism we enjoyed over the rest of the world. Obamacare is a painful lesson in the need to review and renew that history!


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