Health care law needs work, not repeal

Everybody seems to like hybrids. They are often better than the originals that were combined to make them. 
 
Hybrid flowers are among the most prized beauties. Hybrid autos are both better for the environment and practical over long distances.

There is one other thing about hybrids. They usually cost more.

That’s one of the big problems with a huge hybrid that we all own — the Affordable Care Act, increasingly known as the ACA or Obamacare.

Until now, the industrialized world has known only two basic kinds of health insurance. In most developed countries, the government is the single payer, in effect the only insurer, who pays for all costs. The alternative, the traditional American approach, is to leave most health insurance optional and up to private insurers.

The single-payer system guarantees coverage for everybody, while the private system does not. Under the private approach some people go without coverage and get little or no health care.

The ACA is the uniquely American hybrid of the two systems. It is designed to provide coverage to almost everybody while still using an essentially private system.

President Obama and a Democratic Congress decided to develop a program to provide as near to universal coverage as possible. But there was little support to have government as the single payer, in effect extending Medicare to all Americans.

Under the ACA, Americans are required to buy health insurance, and financial help will be provided to those unable to afford it. Private insurance will remain widely available. Nonprofit exchanges are expected to provide a low-cost alternative.

As I mentioned in an earlier column, the ACA was created with known defects. The Democrats chose to enact it, warts and all, to get around a Senate filibuster.

The ACA prescribed a gradual phase-in of the many-faceted plan, due mostly to be completed by next January.

Its design flaws were immediately apparent. It imposes a financial burden on small businesses. Also, some of its rules are costly and complex, making them difficult to put into effect.

The GOP has not accepted the new law and has continually sought to repeal it.

The House of Representatives, under GOP control, has voted 37 times to repeal Obamacare. The Senate, under the Democrats, made sure those votes went nowhere. But the Democrats have not described what changes they would accept.

GOP opposition makes the Democrats reluctant to open the law to change, for fear of creating an opportunity for the Republicans to kill it. Their target is likely to be the exchanges, which could lower costs, putting pressure in the private insurers.

Having failed to eliminate Obamacare, Republicans have found ways to undermine it.

The law allows states to expand Medicaid to ensure that almost all poor people gain access to medical care. The federal government would reimburse all of the added cost for the first three years and 90 percent from then on.

Many states, all under Republican control, have declined this option. It looks like they are willing to sacrifice the health care of some of their poorest citizens in their effort to sink the entire program.

In Maine, Gov. LePage says the state would sign up if the federal government paid 100 percent of the costs for 10 years. To do that, the ACA would have to be modified, impossible because of the congressional deadlock.

If the opponents of the ACA cannot repeal it, they may believe they can make it so unworkable that it will fail on its own. Then, the Democrats might have to accept its repeal.

One problem with the GOP position is that it offers no workable alternative that would produce broad participation.

House Republicans support a federal voucher system under which people would receive financial support to purchase their own private health insurance. To keep government costs under control, the value of the vouchers would be kept low, meaning that many of those without coverage could still not afford it.

Meanwhile, the ACA phase-in continues, providing better benefits to more people. As that happens, stopping it becomes more difficult.

And running against it in 2012 did not seem to help the Republicans.

Developing a hybrid flower requires continuous attention until it is bred to survive. The same is true for the ACA. Like any major new program, it needs follow-up legislation as lessons are learned.

The ACA needs changes, quite a few of them. We would be better served if the GOP accepted Obamacare, the Democrats accepted some changes, and both parties focused on making it work better.