Thursday, September 21, 2017

Ein Bisschen Obamacare Schadenfreude

I haven't had occasion to post two on back to back days for quite a while, but since it's heating up again, it seems necessary. First, via Wombat-socho's "In The Mailbox: 09.20.17" the generally sensible Megan McArdle analyzes the Graham-Cassidy bill to "reform" Obacare: How the Health-Care Debate Would Change If Graham-Cassidy Passes
If Graham-Cassidy passes, it will return us to something more like the health-care politics of yore, because the federal government will be (mostly) out of the health-care-program business (with the huge and growing exception of Medicare). Feds will provide much of the funding. But the states will be the ones in charge of deciding what the system in their state will look like.

Of course, Democrats can one day undo what Republicans are doing, just as Republicans are planning to undo the work of the Democrats. The left can pass another Obamacare, or some different, more expansive plan. But to do so, they will have to go through the whole painful process of passing Obamacare all over again: soothe or pay off all the anxious interest groups; find the extra tax dollars to fund it; reassure voters who have good insurance that they will not lose by the new plan.

This task will be immensely harder in Round 2 than it was in 2010. By the time they get around to it (in 2020, soonest), Democrats will be forced to scavenge for new sources of funding at the same time as every predator on K Street is scouring the landscape to feed our existing defense commitments and rapidly growing entitlement burden.

They will also be trying to whip up support from a public largely exhausted by the last decade of wild promises and underwhelming delivery from both sides of the aisle. Thanks to the experience of Obamacare, that public will be inclined to disbelieve any assurances about how splendid this will be for folks who already have insurance they like. And Democrats will somehow have to overcome all these political obstacles without a once-in-a-lifetime financial crisis handing them unnaturally large congressional majorities.

It is more likely that health-care politics in America will mostly move down to the states, permanently, where they will become vigorous and perennial. This will mean the end of wall-to-wall media coverage of that politics, because the media is nationalizing, while state and local outlets keep dwindling, and it is too hard to get people in California interested in the blow-by-blow details of something happening in Georgia. It will also mean the end of the Democratic dream of a national single-payer system. It will probably mean the end of the dream of single-payer, period, because the obstacles to single-payer at the state level are simply too enormous; it is too hard to control payment when people often cross state borders to seek treatment, and too hard to finance, when states have to run budgets that are at least nominally balanced.
Also from Wombat-socho's "In The Mailbox: 09.20.17", Don Surber in "Let states run health insurance again" concludes "Still, it is a half loaf."

It sounds like a worthwhile step, so why are there (at least) two Republican Senators holding out. Trump: GOP Health Bill Short of Votes Before Deadline. The two senators who will likely decide fate of ObamaCare repeal (Murkowski and McCain). Collins and Rand are assumed out. McCain just enjoys the media spotlight he gets when he obstructs other Republicans. Murkowski?
Alaska has the nation’s highest premiums and benefited from ObamaCare’s Medicaid expansion. Alaska likely would lose out under the latest repeal bill, primarily because it eliminates funding for the expansion and ObamaCare subsidies in exchange for a lump sum of money through 2026.

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