Obamacare: kill it or fix it?

Bernard,

I’ve heard Republican candidates for president say again and again, Obamacare is a travesty and must be repealed immediately after a Republican president takes office.

I’ve also heard Obama administration staff say, no, the Affordable Care Act (ACA) is working, but we can’t solve everything in only three years, and we have to forge on with ACA as our best hope for containing health care costs while improving quality of care.

So who’s right?

This New York Times article brings the question into focus, at least for me. Like No Child Left Behind (NCLB), Boehner and Bush II’s creation 15 years ago, ACA was not engineered properly to take care of boundary conditions. Dartmouth has cut Medicare costs and now coordinates care more efficiently, but Dartmouth hasn’t yet met the Act’s rigid and punitive cost-control targets – therefore Dartmouth has to pay penalties, more than wiping out savings, and preventing them from going on with ACA. Similarly, my wife’s school district was penalized several years ago under NCLB because district standardized test outcomes hadn’t improved by the mandated annual percentages – but the district results were and are near the top in the nation, so there was basically no room to improve! A badly engineered law overlooks edge cases and fails unnecessarily. Just like badly engineered software.

So, should we give up on ACA? Or should we repair and tune ACA, learning from in-the-field outcomes, fostering maturity, gradually realizing its promise?

Given our massive investment in ACA, seems like we should fix it and move on. Same for NCLB.

But gridlock in our federal government will likely strangle ACA slowly, through inaction, leaving us with no plan at all to control healthcare costs while improving care levels. Thus we lay waste to our own nest, our own selves, our own children.  What an awful waste.

Wayne

 

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Filed under Economics, Politics

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