In the parallel hubbubs over the government shutdown and the rollout of the Affordable Care Act, a lot of hot air is being expended by Republicans about their sudden interest delaying the individual mandate in order to “fix” problems in the new healthcare law. As if they truly had an interest in fixing anything (other than “fixing” voter ID laws that aren’t broken to begin with).
Let’s get real. Republicans don't want to delay Obamacare to tinker with it or improve it. They simply want to delay the law's implementation so they can run against it in the 2014 midterms and hopefully regain the Senate on that issue, then try to kill the law afterward.
And once victorious, they'll turn their sites on Social Security and Medicare. That's the game plan. That's their ultimate goal.
But if there are some sincere Republicans who seriously want to talk about fixes to the flaws in the ACA, I’m game. Let’s talk about them.
Five easy fixes
Here are 5 potential tweaks to Obamacare that Congress could pass within days – even after the law takes effect on January 1, 2014 – that would greatly improve how it works:
- Remove the rule that allows companies with less than 50 employees to be exempt from offering coverage and replace it with a gross revenues cut off, so that only companies below a defined gross revenues cap (say, $5,000,000) would be exempt. That would stop companies from laying off or limiting hires to avoid having to offer health coverage. No CEO is going to deliberately limit his company’s gross revenues just to avoid Obamacare.
- Rewrite the section that says employees working under 30 hours per week are excepted from coverage, which encourages employers to cut workers' hours, and replace it with a two tier standard that says employees working 18-30 hours must be offered the lowest cost healthcare plan. Employees under 18 hours would not have to be covered. I doubt that companies would want to double their workforce just to avoid the costs of Obamacare. The cost of training and turnover would outweigh it.
- Fix the family glitch, caused by a drafting error in the original bill, by changing the words “self-only” to “individual or family.” That simple word change would expand coverage for an additional 500,000 children.
- Encourage more states to opt into Medicaid expansion. The money is already appropriated and waiting for the Republican governors to take it. Twenty-six states have already opted in, but a lot of southern and mid-western Republican governors are still holding out – against their citizens’ better interest! Sweeten the deal if need be. If we can get that up to 35 or 40 states that opt in, we could efficiently offer Medicaid coverage to millions of additional low-income families with money that is already “spent” but sitting on the sidelines, waiting to be used.
- Rewrite the corporate tax code, as President Obama has already proposed, to encourage more domestic investment and hiring, and give extra healthcare tax breaks to companies that repatriate their foreign profits back to America. Republicans want to do this; Democrats want to do this; Wall Street wants it; the public wants it. But instead of writing the bill, Congress spends its time battling over short-term funding disputes. You want to lower the deficit and improve the economy? Stop spending your time on 44 votes to defund Obamacare and vote on a realistic tax reform package.
Not enough doctors
The other Republican talking point I keep hearing is that too many doctors are going to opt-out of accepting health insurance sold through the exchanges, or they will retire from the profession.
I say, good! Let them retire. Anyone retiring from the medical field over this measly issue is either not cutting it in his/her current medical practice, or was over-charging for their services already.
They want to leave? Bye-bye! Let's replace them with people who really want to practice medicine.
Let’s open more medical schools and bring more fresh talent into the medical field. Let’s encourage people who want to treat patients and aren’t clinging to a system that has already proven ineffective.
A large part of the problem with healthcare costs in this country has been the exorbitant premium doctors earn for their skill. They won that exorbitant premium on their earnings by limiting the amount of doctors who could be licensed each year and limiting the number of medical school slots open to high-quality prospective students.
According to a 2011 study, the U.S. had 43,919 med school applicants for 19,000 open slots.
That’s not an open market. It’s a rigged market that has served doctors but not the public. We need to open that market to fill the growing demand for healthcare professionals.
Shakespeare was right
"The first thing we do, let's kill all the lawyers," William Shakespeare wrote in Henry VI. Since we're talking about healthcare, we probably shouldn't be killing anyone. But we should certainly decrease the number of law school graduates we produce each year and shift some of that scholastic talent to the medical field.
Why are there currently only 141 accredited medical schools in the U.S. but 203 accredited law schools? How can our national priorities be so warped that we would spend more on creating lawyers than doctors?
Meanwhile, law schools still attract 55,000 applicants a year (though that’s down significantly from prior years). Let’s try to shift some of those top tier students – the Harvard and Yale graduates whom we can assume to be among the best and the brightest of their generation – into the medical field where their high IQs can add something tangible to the world, instead of graduating more ambulance chasers.
Let’s train highly skilled nurse practitioners to be full-fledged MDs, offering grants and scholarships for those who pledge to go into primary care – the area where we need the most new bodies.
Let’s offer hospitals grants to create more residency slots and clinical training positions, which are also in short supply.
And while we're at it, let's graduate more psychologists to man more mental health clinics, so that people who hear voices and shoot out neighbor's tires have the same access to mental healthcare as they do to high power weapons.
Delaying to fix or fixing to delay?
You want to fix the Affordable Care Act? Let’s fix it. You want to improve access to affordable healthcare in this country? Let’s improve it.
But don’t tell me that delaying Obamacare for a year will make things swell. That will only delay dealing with the problems.
And not dealing with problems is a skill that our current Congress already has down pat. Where's the fix for that?