Recently, Paul Ryan and the Republican Party issued their response to the Affordable Care Act. As expected, the plan eliminates the individual mandate and its ineffective penalties. The proposal also eliminates the Cadillac tax and bases its funding on limiting the employee exclusion for health insurance. The non-tax deductible limit would vary based upon the region in which the employee resides. And the GOP says that only the “richest plans” would be affected. I doubt this. Remember, President Obama once claimed, “If you like your health plan, you can keep it.”
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But, this is a lot less radical than I expected. The good news is that the Republicans are looking for some version of incremental change and are seemingly off their repeal and replace mantra.
Winners and losers
Remaking healthcare is going to affect a lot of Americans, and there will be winners and losers. The winners will be quietly happy and the losers will be standing on the pulpits screaming. Radical changes are a lot more difficult to manage, since these changes create more winners and more losers.
And as we have seen with the ACA, opportunists will be looking for profit by gaming or manipulating the system wherever and whenever they can. We have now been through six years of ACA. I, for one, have had enough of radical change.
My hope is that politicians have received the message from disaffected voters. We want legislators to get back to legislating; compromise and gradual change moves the focus to the cost of care.
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I don’t think we are headed to single payer. But clearly, we are moving toward an era of better alignment between employers who pay for the care, individuals who consume care, providers who administer care and insurers who manage the tradeoff between the cost and appropriateness of care. It’s a complex system, but to me, the signs look promising.
