1. Yes: Replace it with a competitive system that puts patients first and cuts costs
The Affordable Care Act (ACA) is the wrong prescription for an improperly diagnosed problem. Consequently, whatever benefits it may provide will be greatly outweighed by its adverse side effects. They will worsen a serious cost problem and degrade senior citizens’ access to care.
What ails US health care is too much third-party payment.
Imagine how the cost of food, another basic need, would skyrocket if Americans were told that government or private payers would subsidize 89 cents of every dollar spent. Instead of addressing these perverse incentives, the ACA will make them worse by expanding the amount of subsidized care and imposing federal control on decisions that most other markets leave in the hands of individuals.
Policies that provide the right incentives would better serve Americans – and significantly reduce the number of uninsured.
In Medicare we can achieve this by switching from offering open-ended packages of defined benefits to giving beneficiaries a fixed amount of funds, which they can use to choose among a broad array of health plans. Officials have already used the same idea for more than a half decade to allow seniors to select their Medicare drug benefits; the fierce competition among plans has helped reduce such drug expenses by 30 percent over time, and by nearly 40 percent in 2011.
Medicaid can follow a similar path if Congress gives states a set dollar amount and allows them to decide how best to manage their programs – a move that would expand consumer choice, increase competition among providers, and lower costs.
Converting the tax exemption for employer-sponsored health insurance to a fixed-dollar tax credit for individuals that varies by income and health status would likewise avert many problems of the current system – and harness the unparalleled shopping ability of Americans to find good value for their money.
Christopher J. Conover is a research scholar at Duke University’s Center for Health Policy and Inequalities Research, an adjunct scholar at the American Enterprise Institute, and author of “American Health Economy Illustrated.”
2. No: The law insures millions more Americans, and it cuts costs
It’s tempting to cite a long list of benefits from the Affordable Care Act. But let’s focus on two core purposes of the law. First, the law makes health insurance accessible to millions who need it the most, including those with preexisting conditions.
But this access is only affordable by encouraging people to get coverage before they get sick – with both carrots (tax credits for insurance) and sticks (penalties for not having insurance). That’s how insurance works: It spreads risk across a large pool of people.
While most Americans already have health insurance, we’re all at risk of losing it. You could lose your job, change jobs, or be diagnosed with an illness. Over a four-year period, from 2004 through 2007, 89 million Americans were uninsured at some point.
These people aren’t lazy moochers; they encounter life’s vicissitudes. To be sure, they could visit emergency rooms to get the most expensive and least timely care – which is still paid for by the rest of us. But this rationing of care is inhumane. Under the new law, Americans will no longer live in fear of financial ruin from health-care bills.
Second, the law curbs health-care costs over the long term.
The law’s reforms to the way health care is paid for and delivered encourage hospitals and doctors to provide better care at lower cost. These savings strengthen Medicare for seniors – lowering their drug costs, premiums, and cost-sharing. This month, for instance, hospitals have financial incentives to reduce preventable re-admissions – motivating them to improve care.
Repeal would make Medicare insolvent in four years and, as my colleagues and I estimate, increase retirement costs by an average $11,100 for a current 65-year-old.
The law’s reforms to the payment and delivery system should be expanded. But they’re already improving care, and this progress must not be rolled back.
Topher Spiro is the managing director of health policy at the Center for American Progress Action Fund.
3. A middle way: Don’t re-argue Obamacare; adjust it
The real question is not whether to repeal the Affordable Care Act. Political rhetoric aside, leaders on both sides realize the importance of some of its benefits (covering preexisting conditions, for instance), and its initial steps to curb costs in Medicare. These provisions are here to stay.
The real question is how to further curb costs and ensure coverage is within reach for all. It is possible to do both. Republicans and Democrats may seem miles apart today, but they have an example in Medicare, which was passed with bipartisan support and adjusted over time by leaders in both parties.
Similarly, in the coming fiscal debate over deficits and debt, we can’t afford to rehash the same all-or-nothing argument between the new law and Republican proposals to give states block grants for Medicaid and to implement a premium-support model for Medicare.
The National Coalition on Health Care has worked with the consumer, provider, health plan, and business communities to chart a new course that controls costs and provides affordable care to all. Here’s what we learned:
Medicare reimbursement and coverage policies have to change. Provider payment must transition from a fee-for-service model that rewards tests and procedures, to one that supports coordinated patient care. Benefits must show good value by lowering enrollees’ co-pays and deductibles when they choose high-quality providers and more effective treatment.
Reform, however, cannot stop with Medicare or other public insurance plans. We must bolster cost-saving competition in private hospital and pharmaceutical markets. To combat chronic disease, we must strengthen public investment in prevention programs and the primary-care workforce.
After the election, Congress will stand face to face with the “fiscal cliff” and the need to cut growth in costs. Our coalition will make specific recommendations then. For the sake of affordability and better care, let’s readjust, not re-argue, health care in America.
John Rother is the president and chief executive officer of the National Coalition on Health Care.