The Next Reform Steps
With House passage of the American Health Care Act, Speaker Paul Ryan and President Trump have revived the GOP drive to replace ObamaCare, but they still have a long, long way to go — and we’re not just talking about getting a bill through the Senate.
Congress needs to look at other factors that drive up the cost of health care.
As we’ve noted before, Republicans spent years posturing against ObamaCare without uniting behind a realistic alternative, and they’re still plainly figuring it all out.
Take pre-existing conditions. There’s nothing wrong in principle with insuring these folks via high-risk pools — if those policies truly offer the coverage they need.
And it makes sense for subsidies for those pools to come from the taxpayers at large, rather than imposing much higher premiums on the relatively few Americans buying individual policies — if you make sure the subsidies are high enough.
Senate Republicans will look hard at those questions, even as they struggle with the Senate’s maddening rules. Majority Leader Mitch McConnell has his work cut out for him.
And this bill is only step one in the overall GOP strategy for replacing ObamaCare. The job may well run into next year — at least. Nor is that strategy sufficient. Congress
also needs to address factors that needlessly drive up health-care costs.
Take the medical-liability mess. Lawsuits don’t just push malpractice-insurance premiums through the roof: Fear of being sued has doctors across America ordering tests they know aren’t needed. Some physicians tell us that fully half of all tests, from MRIs on down, are just “defensive medicine.”
Yes, tort reform has been a state issue. But taxpayers cover roughly half of all US health spending; the sector is increasingly a national one. At a minimum, federal dollars can come with strings requiring states to stop wasting so much “health care” spending on lawyers.
Drug costs are another issue. Democrats love to rail against insurers and pharmaceutical firms on this front — but the most profitable companies here are the middle men: the ones that draw up the “formularies” of what your policy will cover, and at what copay. They bargain down the drugmaker’s list price — and keep most of the savings.
The US health-care system had big problems before ObamaCare added to them. The nation needs Republicans (and any Democrats willing to do more than “resist”) to take them on.