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Jeb Bladine: ‘Repeal and replace’ has a faulty premise

I’ve never been a big fan of the Affordable Care Act as America’s health care solution, partly because it so significantly complicated administration of our company health plan, and also because it did nothing to reduce costs. We all should take an interest in the current “repeal and replace” debate about so-called Obamacare.

Snippets of that debate can be humorous. President Donald Trump, for example, provided comic relief from the dead-serious national discussion when he spoke to a meeting of the nation’s governors at the White House: “We have come up with a solution,” he assured his audience, “that’s really, really, I think very good.”

Whatchamacolumn

Jeb Bladine is president and publisher of the News-Register.

> See his column

That was typical Trump bravado, since there is no solution ready for prime time. Republicans in Congress are arguing over broad ideas for using either tax credits or tax deductions to help Americans purchase health insurance, but the details of any health care plan are far from vetted.

Trump continued with a comment that left my mouth agape: “Now, I have to tell you, it’s an unbelievably complex subject. Nobody knew health care could be so complicated.”

Well, like most people, I knew long ago health care is complicated beyond belief, and from what I’ve read about possible replacement plans, it won’t suddenly become simple and straightforward.

We haven’t prepared for an assault on Medicare from the population bulge of Baby Boomers now in their 70s. We have allowed partisan politics to run amok for decades, never focusing on the core needs and challenges of quality health care.

Unfortunately, the rush to enact one group’s “solution” is likely to go astray due to false premises and unintended consequences.

Writing last month in the Conservative Review, attorney Daniel Horowitz said the idea of manipulating a few policies to replace Obamacare is “built upon an erroneous premise … that it must be replaced with something similar.”

When government enacts complex regulations, there always are unintended consequences. Horowitz argues that we should repeal Obamacare, eliminate mounds of regulations, and depend on the marketplace to expand health care access and affordability through innovation and competition.

I agree with Horowitz that “repeal and replace” is based on wrong assumptions, but I don’t share his confidence in the private insurance marketplace. The United States stands almost alone as a developed, wealthy society without some form of universal health care.

We’re going to arrive there eventually, so we might as well start now.

Jeb Bladine can be reached at jbladine@newsregister.com or 503-687-1269.

Comments

Mike

I am surprised so few small businesses support a universal health care plan like Medicare for everyone. Paperwork is reduced to payroll process. If an employee wants supplemental coverage they can buy it on their own.

Seabiscuit

And Mike, which Doctor is going to take this Medicare program? Last year, we spent over 6 months trying to find a Doctor for my mother to replace her old Doctor that retired. None of them would accept her as a new patient because she was on Medicare.

And if the government Universal health care is so good in the other countries, why do so many Canadians cross the border to get their health care?

Bill B

Let's face it. Any program, and I mean any, controlled or run by the government is inefficient. I for one do not wish to wait a year for necessary surgery or worse yet that I'm told I'm too old to have a procedure.

kona

What most people don't realize is that Americans demand (influenced by our legal system) about every test and procedure to cure their ills. There is not a cheaper way for our health system in America. Coupled with that, the American lifestyle is among the least healthy in the world.

Jeb Bladine

I've been responsible for a small business health insurance plan for 30-plus years, a time of continuous increases in cost of health care, health insurance and out-of-pocket cost to insured people. I've often wondered why we have tied health care for so many people to the financial ups and downs of the small and medium-sized companies they work for. Here's a real-life example: A family pays $9,000 annually for health insurance, and any significant health situation affecting any member of the family likely will create $6,000-plus in additional out-of-pocket costs. I can only encourage a close look at the research showing that we spend by far the most on health care with some of the worst health results among developed nations. It gives new meaning to “We're No. 1.”

Michael

Why, if we are required to be on Medicare (and I'm OK with that), do doctors have a right not to take Medicare?

We do not have an excellent health care system in the U.S. What we have is the greatest surgery system. Americans need to take more control of their health through proper eating, weight control, and exercise.

Mike

A single payer like Medicare is a safety net basic coverage for everyone. Nothing to prevent supplemental insurance coverage for those who can afford it. There are solutions to improved access to medical treatment. Train more doctors with encouragement to work in rural or poorly served areas, allow more general practitioner work like routine check up and minor procedures to Licensed Practical Nurses (Kaiser does that now), and limit tort claims are a few ideas.

Mudstump

Bill B - Medicare is a successful program with very low overhead compared to private insurance. A Medicare for all plan that we could buy into would be a good idea imo. Between Medicare and the VA, my father a WWII vet got excellent care before he passed.

Bizzyditchaz

The notion of health insurance to be through one's employers is THE MOST ridiculous part of this whole cluster *expletive* of a "health care" system! How is it, in a Right to Work state, is an employee supposed to be eligible for health insurance at 32 hours always scheduled for 31.5 a week, just to stay shy of the golden ticket of 32 hours per week? Never getting there THROUGH the employer! I speak from experience on this one as it is VERY common practice and has been since I began working in 1986!!

Jeb Bladine

Bizzyditchaz,

You're right about employers often avoiding expensive benefits through part-time employment. Sometimes, particularly for job needs of 15-20-25 hour per week, it makes the difference between hiring or not hiring at all. But that can be abused, as you say.

But here's an interesting twist in recent years:

Due to greatly increased cost of health care premiums on company plans, many people are better off with Obamacare policies that are subsidized based on their income -- subsidies they don't qualify for if they have access to a company health plan.

Lots of complex issues watching the health care debate this week in Washington, D.C., and around the country.

Mudstump

We see what the republicans have in mind for "repealing" Obamacare. Paul Ryan's plan will cut Medicaid and deny millions of poor people healthcare coverage and the ability to see a doctor. Paul Ryan claims to be a devout Catholic. I wonder how he squares his distain for people in need with his religion....a religion that disagrees with Paul Ryan btw. He almost giddy when he says this; "We are de-federalizing an entitlement, block granting it back to the states, and capping its growth rate. That's never been done before." What he doesn't say is that the republican plan will give $275 billion in tax breaks to the top 2% over ten years. I guess giving wealthy people more tax breaks is more important than keeping people alive. He literally wants to take from the poor....people who have little means...to give to the rich.

kona

Mudstump, is this a blanket condemnation of Republicans? You said, "We see what the republicans have in mind for "repealing" Obamacare". This plan is not set in stone and is a long ways from it. There are many Republicans who are at odds with this initial plan. So why start (continuing) making personal jabs at those trying to make a program that improves upon the ACA? The ACA, as everyone agrees, was/is heading for a disaster. Remember all of those "promises" that were made by President Obama that haven't materialized? You might be heartened that this plan is being made public before voting as opposed to the way all Democrats voted on the ACA before anyone in congress read it, let alone anyone from the public. Is it your purpose primarily to denigrate Republicans, or what?

Mudstump

kona - Correct me if I'm wrong, but wasn't the proposed repeal and replacement authored by republicans? Yes, I've read that some republicans are against the plan, but the extreme members of the republican party want to ram this legislation through without even one hearing to determine the impact on Americans. What's the hurry? Is it because they know that the American people will be appalled when they actually learn what it will do? Republicans know that once people read the bill and realize that this is about giving huge tax breaks to the wealthiest people at their expense...they will be angry.

kona

Mudstump you asked, "... wasn't the proposed repeal and replacement authored by republicans?" Absolutely and that is one of the primary reasons why we have a President Trump and not a President Clinton. No news there, the choice was well presented before the election when most people had a negative view of the Affordable Care Act.

You said, "... extreme members of the republican party want to ram this legislation through without even one hearing to determine the impact on Americans". Who are these "extreme members"? Was President Obama "extreme" when he "rammed" ACA through when no member of Congress read the bill before voting on it and there weren't any public hearings on the finished content?

Then you asked, "What's the hurry?" Again, the Democrats voted without reading what they were voting on. Why is that sanitary for you? I agree that there is no hurry, there shouldn't be and there isn't. It will be a while before there is any vote by either the House of Representatives nor the Senate. It seems like CNN and MSNBC are always begging for something to happen immediately so they can play the "gotcha game".

Additionally you asked, "Is it because they know that the American people will be appalled when they actually learn what it will do?" Are you referring to the negative response of the "American people" when the Democrats passed the ACA? Before you get too excited, the Republican bill is far from a finished project.

p.s. It is entertaining how you refuse to capitalize "Republican" or utter the words "President Trump".

Mudstump

kona - it sounds like you are "a-okay" with the repeal of a law that provides millions of people with healthcare that they didn't have access to before. Why are the republicans using the budget reconciliation process to ram this through? Maybe they don't have the votes for the legislative approach? Why are the republicans giving billions of tax breaks to the wealthiest people while leaving people in need of care to die?

treefarmer

No Mudstump, you are not wrong. And I agree that the behavior of the republicans in Congress does, in no way deserves capitalization. Shame on the lot of them. They continue to put party ahead of country in every arena. Their hope to attain a few short-sighted perks justifies blind tolerance of the mad puppet-king in the White House. I too refuse to identity him as President. He continues to “deconstruct” (quoting puppet-master Bannon here) the government: from health care to the environment to national security to foreign relations and beyond. He will continue to lie and obfuscate and perpetrate chaos on America until his supporters realize how badly they have been duped and how painful the price is going to be. I have faith in American values, and the will of the people to fight for them, as we always have. In the meantime, my heart goes out to those who will be victimized by this cruel theft of compassionate health care in trade for fat tax breaks for the wealthy. The ACA needs to be repaired not destroyed.

“Make America sick again.” Now that would be truth in sloganeering.

kona

Mudstump you said, "kona - it sounds like you are "a-okay" with the repeal of a law that provides millions of people with healthcare that they didn't have access to before". I am "a-okay" with anything that makes healthcare better, more accessible and more affordable. I personally don't believe it is possible for either Democrats or Republicans to make that happen. It certainly hasn't worked for the Democrats. This is mostly Republicans and Democrats firing back and forth with each other. With ACA millions of people were forced to buy health insurance whether or not they wanted or pay a penalty. That is why "millions of people with healthcare who didn't have access to before". I don't agree that forcing purchase of insurance is necessarily a good thing.

You asked, "Why are the republicans using the budget reconciliation process to ram this through?" This will not be "rammed through" because there aren't the votes to "ram" it through. Why did Democrats "ram" the ACA through without even reading it first? Your biased perspective appears suspect.

You asked, "Why are the republicans giving billions of tax breaks to the wealthiest people while leaving people in need of care to die?" They aren't, this bill is not close to a finished product.

kona

treefarmer said, "... the behavior of the republicans in Congress does, in no way deserves capitalization. Shame on the lot of them".

Can you be more specific about your inflammatory statement? What are they collectively doing differently than what they have done that has put Republicans in their strongest position since the 1920s? Or, is it your liberal/progressive,Socialist/Democrat (pick whichever one that fits) perspective that overwhelms you?

kona

Treefarmer, on the other side of your comment, what are the Democrats in Congress accomplishing that makes you so proud?

Lulu

I truly like "mad puppet-king in the White House."

Speaking of "king," much of what's happening currently reminds me of "The Emperor's New Clothes." It took an unsophisticated young child to speak the truth and proclaim him naked.

Mudstump

Kona - there were many meetings in Congress, meetings with experts, consultations with experts and stakeholders involved before the ACA was passed. It was an exhaustive process, but who knew that healthcare could be so complicated...right? No one is claiming the ACA is perfect, but it made it possible for millions of people to be covered by insurance that weren't covered before. It is keeping Americans from going bankrupt because their kid got sick. Its keeping the cost from rising at the pace pre-ACA, its saving people like me money because my son could stay on my plan until he was 26....it eliminated pre-existing conditions and lifetime caps and much more. The republican plan doesn't address these things. And, since when is it okay to mooch off of others by not having health insurance? So, you think people should not carry insurance and make the rest of us pay when they end up in the emergency room? That's pretty irresponsible don't you think? The bottom line is the republicans don't care if Americans can't see a doctor....they don't care if people die because they can't afford coverage...they only care about the wealthy and making it possible for the rich to feed off the American taxpayer. Just wait until Trump's "Goldman Sachs" appointees reverse all the protections in place to keep Wall Street from being bailed out by the taxpayer. It's coming.

Mudstump

And Jesus Said Unto Paul of Ryan ...
by Nicholas Kristof

https://www.nytimes.com/2017/03/16/opinion/and-jesus-said-unto-paul-of-ryan.html?smid=tw-share&_r=1

kona

Mudstump, you said "The republican plan doesn't address these things".

You are not paying attention or have blinders on. The Republican plan (which is not yet finalized) addresses all of those situations. Why are you so excited about something that is still in a formative stage?

You asked, "And, since when is it okay to mooch off of others by not having health insurance?" Are you referring to your son who is approaching 26 years old and still "mooching" off others? I don't condone mooching either, but I don't have any idea what your point is concerning the "mooching" and health care.

You asked, "So, you think people should not carry insurance and make the rest of us pay when they end up in the emergency room?" No, but that is the way it is. We either pay for the ER or we pay in increased health insurance premiums or taxes. Whichever way it is we pay for a great segment of society that doesn't pay their own way (think of a 26 year-old person still being on their parent's health insurance).

You said, "The bottom line is the republicans don't care if Americans can't see a doctor....they don't care if people die because they can't afford coverage...they only care about the wealthy and making it possible for the rich to feed off the American taxpayer."

You are making statements that rival President Trump for reality. Good luck with that.

p.s. You aren't suggesting that Paul Ryan govern by his religion, are you?

Mudstump

"p.s. You aren't suggesting that Paul Ryan govern by his religion, are you?"

Then he should quit telling us what a devout Christian he is.

My son stayed on our plan while he attended Portland State for his degree in biology and the following two years he spent going to nursing school. He is employed full-time as a nurse and supports himself completely. I don't see that as mooching...do you? We pay for private insurance...we get no subsidies or special taxpayer benefits because we don't need them. Why should parent's pay for an additional plan for their college-age kids when they are already paying for a health insurance? Would you like consumers to pay for something twice just because the insurance company wants to make a bigger profit?

kona

Let's see, graduate from high school at age 17 or 18, graduate from college at age 22, two years nursing to age 24. Yes, health insurance until age 26 is quite a generous health program. To be sure, every mention by the Republicans keeps this generosity intact.

You asked, "Why should parent's pay for an additional plan for their college-age kids when they are already paying for a health insurance?" How about all of those kids who don't go to college? Or, are finished with college at age 22? Does that fit into your "mooching" category when other people pay for that provision when they don't have children?

You asked, "Would you like consumers to pay for something twice just because the insurance company wants to make a bigger profit?" How does that happen?

p.s. You said, "Then he should quit telling us what a devout Christian he is." Are you kidding? Do you have a problem with free speech? Or, freedom of religion? Or, government employees following a religion?

kona

Mudstump, I congratulate you for raising your son well and him for the academic endurance. I know it makes a parent proud. Good job!

Mudstump

kona - thank you for the compliment. I have no problem with people practicing any religion they wish, but one shouldn't boast about how much their religion means to them and how devoted they are to the doctrine while proposing laws that directly contradict the teachings. That's called hypocrisy and it has nothing to do with restricting their freedom of religion. Paul Ryan is free to be a hypocrite, but I am free to call him out on it.

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