Monday, April 3, 2017

Obamacare Escapes the Maelstrom--On

by Michael Liss
That was quite close. But for a handful of votes, and some hubristic miscalculations, virtually all of the ACA would have gone down in a whirlpool of tax cuts and denials of coverage. 

And yet, the monster lives. The temptation is to fill volumes with the how and the why, all the inside baseball, who disliked whom. But, being the sort of person who is naturally attracted to dull, I am going to talk about AHCA and ACA without ever mentioning Donald Trump, Paul Ryan, and the Freedom Caucus. Spoiler alert—read further and you enter a sea of boiling wonkiness. 

Let's state what the last few weeks should have made obvious: For all the bloviating the overwhelming majority of Congressmen and Senators really don't know what they are doing when it comes to healthcare. They don't understand population health or public health issues or patient needs. They don't understand insurance. And they don't understand economics.  
No one should be surprised by this. Politicians rarely have granular knowledge in any field other than politics. Rather, governing is basically the mechanism through which the expertise of other, more informed people (in industry, academia, and inside government itself) is filtered through a political philosophy, debated, transmitted (or sold) to the public, and enacted.

Most of the time this process works—crudely, without attention to fine detail, without being perfectly engineered. Americans have been blessed with great assets. We can usually afford the inefficiencies that have ideology (or just garden variety spoils) triumphing over technocratic precision. Besides, there is always another election coming.

But healthcare is just too complex and nuanced and just plain important for bumper-sticker governance. We really do need deep knowledge and a multidisciplinary approach to have the slightest chance of drafting credible legislation. Whether we like ACA and want to improve it, or hate it and just want to blow it up, the least we can do is make an attempt at understanding its key components.

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