Obamacare: Show Us Your Fixes!

Mickey Kaus Columnist
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It’s Past Time to Talk About Obamacare Repairs: Byron York notes the pathetic answers Dem congressional candidate Alex Sink gave when she was asked (by her now-victorious opponent, David Jolly) how she’d fix Obamacare:

“Sink had two proposals. She would allow the government to negotiate for lower prescription drug prices for Medicare, and she would repeal the medical device tax — neither of which would address the problems Obamacare has created for millions of Americans. Sink said there were many other fix-it ideas she could have discussed, but she did not say what there were.”

If Democrats want to run on a “mend it, don’t end it” platform regarding  Obamacare, they’re going to have to do better than that.

York goes further,though, and argues they can’t do better than that without having to

“advocate fundamental changes in the law that they have so far steadfastly refused to accept. Get rid of the individual mandate? To do so would rip the heart out of Obamacare, tantamount to repealing it altogether. Many Democrats would rather lose than do that.”

I don’t see why this is true. Aren’t there lots of potential fixes that might make the (admittedly flawed) Obamacare design work much better? Did Dems lard on too many required benefits (like drug and mental health treament, and pediatric dentistry)? Well, pare them back! Obamacare supporter Harold Pollack has already suggested as much.  That would presumably reduce the cost of the plans, making them more affordable to now-reluctant stickershocked purchasers — and lowering the cost of subsidies. Use some of the subsidy money to smooth out and extend the subsidies’ reach into the middle class — right now they cut off brutally sharply at 400% of the poverty line, punishing anyone who gets a raise or works harder with an actual decrease in net income.

I’d argue that everyone in the system, even the affluent, should be subsidized to some extent — as opposed to the shut-up-and-take-it approach of backers like Jonathan Gruber, who argue that middle class “genetic lottery winners” who happen to be healthy (and stuck in the individual insurance market) should just accept the penalty of being lumped in with everyone else. Given the hundreds and hundreds of millions in new taxes imposed by the Affordable Care Act, Americans have a right to expect at least a bit of a free lunch when they go to the exchanges. Right now, Obamacare is like a party that could be good, but never gets started because each wave of arrivals looks around, thinks nothing is happening, and leaves.  Individuals forced into the exchanges with the previously uninsured are not having a happy experience. That will make it harder for small business employees and others to join the exchanges later. Time to sweeten the punch bowl.

Insurers could maybe also be allowed to charge old people a little more and young people a little less. And there must be some way to speed up the process by which competing plans are forced to broaden their too-narrow, HMO-like doctor networks.

Do these changes “run afoul of party orthodoxy”? Not really. The basic structure of Obamacare might remain — in fact, the changes could substitute for more destructive but showy political fixes like abolishing the individual mandate. Would they require Dems to pay a “high political price”? Certainly not higher than the price they’re paying now. Would they require Democrats to in effect admit error — that they “went too far” in building out Obamacare? Well, duh! Voters tend to like admissions of error, especially if they seem likely to lead to better policies in the future.

I’m sure many Democrats have lists of potential fixes sitting on aides’ computers. If there were ever a time to print them out and make them public, this is it.

Just please don’t call it a “conversation.”

P.S.: Publicizing the fixes would also allow a useful contrast with  proposed conservative fixes, which sometimes seem just as complicated and unappealingly government-directed as the A.C.A. (see, e.g., discussion of the “opt-out auto-enrollment process for recipients of the [Coburn-Hatch-Burr health insurance] credit”).

P.P.S.: Josh Marshall sneered at my desperate, hack idea of appointing a commission (headed, ideally, by Bill Clinton) to propose Obamacare fixes. I wonder if he’s still sneering. A commission would come in especially handy if, as is probably the case, some of the fixes (like broadening the subsidies) would require an extra infusion of federal dollars. … Unless they were readers of Wonkblog, did average American voters really think expanding health coverage to virtually all Americans would be cost neutral?

Mickey Kaus