Repeal of reform won’t fix our health system

The system we had before health reform became law was simply not working. I think we can all agree on that. A significant number of people oppose “Obamacare.” I can understand that. But repeal doesn’t really solve the problem. Sure, if you think that health reform has or will actually make our system worse than it was before, it seems prudent to undo the legislation, but that brings us back to square one–a system that wasn’t working well for most Americans.

Repeal must only be the first step, to be followed by a far more important next step: How do we improve the health care system? In other words, if “Obamacare” isn’t a step in the right direction, what pray tell, is? This is the area where I’ve not seen much in the way of developed proposals. Sure, John Boehner announced a plan that would eliminate the individual mandate while preserving the new ban on pre-existing condition exclusions, but that only makes for good politics and terrible policy.

When one element of reform is popular and another element is unpopular, it makes people happy when you tell them that you’re going to keep the popular element and get rid of the unpopular one. The problem is that the two elements were purposefully designed to work in concert, according to economic theory and human behavior, to avoid some rather disastrous consequences. Unfortunately, most people don’t think through these types of things, preferring to stop analyzing the situation once they feel happy.

The result of this particular promise would be skyrocketing insurance costs. Why? Because many people would choose not to buy insurance until after they got sick. After all, they wouldn’t be required to buy it when they didn’t need it, and they wouldn’t be prevented from buying it just as soon as they needed it. This practice would undermine the entire principle of risk-pooling and uncertainty upon which the insurance industry rests. As a result, most of the people who bought insurance would be sick, and that would make coverage wildly expensive. John Boehner knows this, but he doesn’t talk about it on television because it wouldn’t be popular.

So, I’d like to see some substance. Call for repeal if you like, but show me your alternative plan for reform. That is, unless you think the system is doing just fine, in which case I’d love to see some data to support that assertion. Either way, I want to hear an explanation grounded in evidence, not just a collection of bullet points that cater to people’s feelings.

Brad Wright is a health policy doctoral student who blogs at Wright on Health.

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