Henry Clay made clear the role of Congress when he said, “Politics is not about ideological purity, or moral self-righteousness, it’s about governing. If you cannot compromise, you cannot govern.”
Democrats and Republicans have ignored this wise counsel in writing flawed health care legislation. Democrats wrote the Affordable Care Act without any Republican involvement, for which they justifiably complained, and now Republicans in both the House and Senate have done the same thing. Both have pandered to their bases while ignoring the best interest of all Americans.
Repeal and replace has become an end unto itself.
The problems with the ACA have been well documented — exchanges are closing, companies are withdrawing from an increasing number of areas, premium increases are rising at double-digit rates, and healthy young Americans are not participating as assumed. In addition, Medicaid continues to have serious problems.
None of the health care insurance problems are going to be solved until members of both parties start with a clean sheet of paper and use hearings to obtain the best advice on a path forward.
There are a few basic principles that should guide health care legislation. The first is that as the wealthiest nation in the world, the least well off should not go without health care. It would be shameful not to provide an adequate safety net for the poor, the infirm, and those unable to work — those who cannot afford insurance through no fault of their own.
Reforming Medicaid should include a well-thought-out safety net. There is no disagreement that Medicaid’s costs are out of control. One reason is the repeated expansion of eligibility and benefits. Shared funding has created perverse incentives. States should have the ability, within reasonable guidelines, to experiment to improve its structure and incentives. They should be rewarded for reducing fraudulent enrollments and claims.
Congressional hearings are a way to illuminate the range of options for improving Medicaid while maintaining a basic safety net and controlling federal budget costs.
Insurance premiums will never reflect the benefits of market forces until there is real competition. Exchanges were supposed to bring that about but failed. Alain Enthoven, a professor at Stanford and a leading health care economist, has written extensively on the benefits of regional exchanges. States and employers could work together to create regional exchanges so that employees and citizens in those states would have multiple choices that are competitively priced. Allowing policies to be sold across state lines would be an important step forward.
Health care costs are and have been out of control. A National Academy of Sciences report estimated that 30 percent to 40 percent of health care spending is pure waste. Hearings would help to identify the sources of that waste and corrective actions.
Among those would be options for lowering the cost of prescription drugs. FDA could be granted authority to allow imports from countries that have drug safety standards similar to ours and could streamline the drug-approval process to lower development costs. Medicare could be given the authority to negotiate drug prices with pharmaceutical companies. Companies such as Kroger, Costco and Sam’s Club have demonstrated the power of size in negotiating drug prices. Other membership organizations could do likewise.
One of the problems with the ACA is that not enough healthy young people signed up for insurance in spite of its mandate. There are alternatives to a federal mandate and states should have the flexibility to explore them. The objective is to maximize coverage and avoid shifting the cost of treating the uninsured to those who have insurance.
Providing for portability and coverage without regard to pre-existing conditions is important. High risk pools with state and federal funding or other funding mechanisms could address the adverse risk effect on insurance costs.
Continuing to engage in partisan bickering is irresponsible. There should be enough members of Congress from both parties who are willing to work together to solve the worsening problems of the ACA. A country that once saw itself as the shining city on the hill should not have a second-class and failing health insurance system because Congress refuses to govern.
