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On the Third Hand: Blaming the Victim

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The House Energy and Commerce  Committee has organized some really interesting hearings about the Patient Protection and Affordable Care Act of 2010 (PPACA) over the past year.

The hearing organizers on the committee have brought in witnesses who have talked about PPACA implementation glitches and concerns that should be of interest to anyone who is following U.S. health policy, or who wants the economy to run well.

My guess is that some of the organizations setting up health plans through the Consumer Operated and Oriented Plan (CO-OP) program will do a great job, if they get a real chance to bring CO-OP plans to life, but of course Congress should be asking tough questions about a multibillion-dollar loan program.

Along the same lines, house Republicans were right to be asking whether HHS actuaries thought the PPACA Community Living Assistance Services and Supports (CLASS) voluntary long-term care benefits program would make financial sense. I wish Congress could come up with a compromise law that would help the CLASS program sustainable — and laws that would make private long-term-care insurance more clearly sustainable — but it looks as if the House Republicans were right about the idea that the version of the CLASS program described in PPACA is a mess.

 But the Republican Energy and Commerce leaders and other Republicans in the House have been doing everything they can to strangle PPACA and starve and browbeat the U.S. Department of Health and Human Services (HHS) officials since PPACA was passed.

Now the committee Rep. Fred Upton, R-Mich., the chairman of the committee, and Rep. Joseph Pitts, R-Pa. the chairman of the committee’s health subcommittee, have sent Marilyn Tavenner, the acting administrator of the Centers for Medicare & Medicaid Services (CMS), a letter complaining about delays in PPACA implementation.

Upton and Pitts sent the letter a few days after we published a fine article by Mark  E. Ruquet — a reporter for a sister website, –on state regulators’ concerns about delays in getting PPACA implementation regulations and guidance from HHS.

On the one hand: If Upton and Pitts sent the letter to Tavenner because they read Mark’s article: Yay!! Thank you for reading.

On the other hand: Who knows whether HHS officials even like PPACA. Maybe Tavenner hates PPACA more than typical members of the National Association of Health Underwriters. Maybe she has a voodoo doll named “Ppacka” and sticks pins in it every night and every morning. But her job is implement PPACA, and the House Republicans have hauling her in for hearing after hearing, doing everything they can to reduce PPACA implementation funding, and, in general, treating her as if she were the Ppacka vodoo doll. Except that, instead of sticking pins in her, they’ve been focusing on tying her up in miles of legislative rope. It seems really unfair of them to wonder whether the regulations and guidance are when they’ve done their best to tie her up.

On the third hand: One of the lessons of the story of Harry Houdini, the escape artist, is that, the longer the rope is, the more likely it is loose and the knots poorly tied. Maybe, by attacking HHS and PPACA so often, from so many different angles, PPACA opponents have actually used too much rope and accidentally given the Obama administration more freedom to implement PPACA how it wants than if the opponents had waited quietly and unenthusiastically to see how the law will work (or fail to work).


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