The Health Care debate

I made the pretty obvious prediction that fixing our healthcare economics isn't going to be easy. Changing 50 years of accumulated bad government policy is problematical, not so much because we don't know what the problems are, but more because the public has gradually accommodated itself to the present system. Abrupt changes are disconcerting and can do some real harm, at least temporarily .

President Trump has made the statement that making the change was harder than he thought. You can't fault him for that because to really know the problems you not only have to be immersed in the system in some way but also to have really given it a lot of thought for a long time. And beyond that you have to understand the politics involved in turning the battleship around without sinking the rest of the flotilla.

President Obama likewise had extremely limited understanding of healthcare economics. He wouldn't be expected to know much given his lack of background in the subject. During the Obamacare debate, for example, he made some very foolish statements about how doctors behave. Whether he understood his lack of knowledge is hard to say. He never admitted his surprise as Trump has. Speaker Pelosi and Senate Leader Reid were in the same boat. The ACA was mostly devised by policy wonks who had no particular complaint with the old system and just wanted to bring everybody into it. The politics was much easier because of the overwhelming congressional Democrat majority, including 60 Senate members, but even so it was a hard sell.

President Trump has some advantages. HHS Secretary Price has a deep personal understanding of both the medical and the legislative issues. Speaker Ryan has an overwhelmingly better grasp of the issues than did Speaker Pelosi, although she is said to be good at head counting when it comes to passing legislation.

Senator Schumer and the Dems, as expected, have turned their faces against the new American Health Care Act for the time being. Whether they can hold fast against items, which will be presented later, that promise to substantially lower the cost of health insurance and health care generally remains to be seen. Meanwhile we are now seeing a battle royal among the Republicans. As one political commentator said this is an old time legislative fight, something we haven't seen in decades.

I think Ryan and Price's basic goals, designed first and foremost to lower the cost of health care and then to make sure that everyone has access to at least basic standard medical treatment, are widely accepted among the Republicans. The argument is about the politics of how to get there. It's really pretty interesting. The opening gambit of the AHCA was laid down and now there's a pretty public debate. It reminds me a little bit of what I've read about how things went when our constitution was being devised. The points of reference are pretty disparate at this stage and we'll see what compromises can be reached. If there was ever a time for President Trump's deal making skills this is it. He is said to be working very hard at it.

I've heard the argument put forth that Obamacare is collapsing financially, that we should just let that happen and then people would clamor for a solution. That road would lead to disaster. The Republicans were elected in part to fix this problem and they'd better do it.