Putting Obamacare Out of Its Misery–16fh.,b13.14
Discontent with Obamacare—and with the delivery of health care more broadly—unites most Americans across our other divisions. That discontent creates enormous opportunities and risks for our president-elect.
The new administration would be misguided to start a typical Washington process that brings the usual suspects to town for dull sessions that grind out pablum that no one will digest. On the other hand, they will not inherit a detailed roadmap from congressional Republicans and should not expect that any Health and Human Services (HHS) transition team, no matter how talented and focused, can quickly create a workable plan in isolation.
The president-elect should begin by following through on a proposal that he embraced in the closing months of the campaign: interstate sale of health care insurance. Letting the market work without the barriers to entry that limit competition should be much easier to legislate than other mind-bendingly difficult details of health care regulation.
Sooner than that—the sooner the better—he might want to schedule a one-day meeting with governors and insurance company chief executive officers (with absolutely no substitutions of more junior people). That meeting should begin with a firm declaration by our president-elect that interstate sale of health insurance is going to happen and that the only purpose of the meeting is to determine the authorities that the states will retain. This meeting should have the transparency that President Obama promised, but did not deliver, for the drafting of Obamacare—the discussion should be open to the media.
After his opening charge, he could leave the group with a representative (perhaps former Utah governor and HHS secretary Michael Leavitt) to define principles for which there is a substantial consensus. Acceptable principles should then be forwarded to Congress for incorporation into its Obamacare repeal legislation.
Despite these issues, the best answer may be to leave the basic infrastructure in place and make the exchanges fully voluntary. States should only have to meet minimal federal standards for their exchanges and should have the discretion to devise innovative approaches for the needs of their own citizens.
Why preserve even this much? Because the new administration will not readily find a more efficient tool than the exchanges for continuing one of the few successes of Obamacare: its mechanism for purchasing individual and family insurance for people who do not have coverage through an employer. Such a mechanism becomes more important if you want to encourage competition, by letting insurance companies sell policies across state lines; without a centralized portal new entrants are likely to be overlooked.
Elimination of compulsory insurance would also allow the Trump administration to put capital into its relationship with millennials. Millennials rightly resent baby boomers, who have enriched themselves at the expense of future generations. Millennials resent Obamacare’s fines for failure to buy gold-plated insurance plans that subsidize older Americans. They resent an older generation that imposes far more student debt on today’s students than the boomers themselves had to bear. They resent the fact that Social Security is paying out more today than they can expect to receive when they retire. Moreover, when they think hard about Social Security, they resent the Clinton-Sanders proposal that would jack up their taxes and kill their jobs in order to subsidize benefits for today’s middle-aged workers.
While it is important symbolically for our president-elect to put his stamp on Obamacare repeal legislation, he can also fix many problems—with Obamacare, Medicare, and other programs—by issuing executive orders in his first few days. As examples, he can:
(1) order destruction of the massive secretive MIDAS database of about 10 million exchange users that HHS has unethically and illegally assembled;
(2) order HHS to suspend for 180 days any new directives that burden physicians and to provide OMB within 60 days with a list of Obama administration directives that burden physicians so that OMB can recommend which directives need to be withdrawn; and
(3) order HHS to suspend immediately all sharing of data controlled by Obamacare “navigators” with outside organizations—data that have found their way into partisan organizations for partisan purposes.
The new administration also should take prompt action on the problem of rising drug costs, without engaging in command-and-control regulation
Drug companies want a variety of benefits from HHS when it comes to reimbursement, technology transfer, and other functions, so it should not be hard to end a noncompetitive practice that is more cultural than economic.
This topic serves as a reminder that our president-elect can’t afford to overlook the FDA, which has become more dysfunctional as it has become more beholden to Ralph Nader’s innovation-stifling Public Citizen. Our president-elect should insist that the agency instead prioritize saving dying children. I
Traditionally, all political appointees submit their resignations to the incoming president, although FDA commissioners have a history of working hard to sidestep that tradition. Having had a back-row seat to the passage and early implementation of Obamacare, I believe that dismantling Obamacare and replacing it with a more compassionate and effective Republican alternative will be more complicated and stressful than most of our president-elect’s advisers can possibly imagine. Firm, strategic action in the initial days will be critical to the mission—and critical to the public’s initial assessments of our new president.
source–weekly standard, michael astrue, rob califf, dr janet woodcock,