One econ major, three opinions

A Republican governor in New Mexico is moving ahead with efforts to start a Patient Protection and Affordable Care Act (PPACA) health insurance exchange for her state.

Some other Republican governors have refused to start developing PPACA exchanges for their states.

Some readers of LifeHealthPro.com and a few members of Congress really are fervent free-market libertarians who don’t think the federal government should have any involvement in ordinary health care finance.

Most of the Republican governors involved in the PPACA health exchange story seem to have accepted the idea that at least some federal government involvement in health care is a necessary evil. It doesn’t seem as if any of them has tried to send all of their states’ Medicaid funding back to Washington.

So, to me, it looks as if this is a conflict involving different types of government interventionists.

The main argument of some of the governors who are sitting out is, basically, that the PPACA drafters were a bunch of Commie bozos.

Some other, more temperate PPACA opponents, such as South Carolina Gov. Nikki Haley, are saying that they are sitting out because, even though the U.S. Department of Health and Human Services (HHS) has talked about offering states as much flexibility as possible, HHS hasn’t really allowed states enough flexibility to run the exchanges how they’d like to run the exchanges.

To me, it seems as if the following principles shape the PPACA exchange stand-ff:

  • Most Republicans could actually live with the idea of insurers selling insurance through some kind of exchange. The governors who led efforts to set up the two existing state exchanges, in Utah and Massachusetts, were Republican governors.
  • The PPACA exchange rules, such as the rules governing new PPACA risk-management programs, are really complicated, may conflict with each other, and, in some cases may well contain glitches that would horrify any health care actuary or other risk-management expert, whether that expert was a Democrat, a Republican or a loyal LaRouche supporter. Chances are that no one in Congress is madly in love with the PPACA risk-management programs.
  • Republicans have had a history of preventing the Democrats from fixing PPACA, even when Democrats might have been willing to fix it, by focusing mainly on bills designed to kill off PPACA as a whole, or major chunks of PPACA, in ways that would be as humiliating as possible even for a Democrat who liked PPACA. The overriding goal seemed to be to make sure that PPACA would be as horrible as possible, to maximize voter hatred of the Democrats, rather than to maximize the well-being of the country. The one time the Republicans relented and proposed a PPACA fix bill that a Democrat could vote for — the 1099 fix bill — President Obama ended up signing the bill into law.

A modest proposal: Maybe the Republicans could demonstrate that they are serious about trying to be part of the solution, rather than part of the gridlock problem, by developing a PPACA fix bill that has strong appeal for health insurers, health insurance agents and the senators commonly identified as being moderate Democrats.

The Republican lawmakers who drafted the bill would have to refrain from implying that Democrats are all un-American Marxist-Leninists while the bill was under consideration.

The bill could not include any obvious poison-pill provisions, and it would have to be the kind of bill that the American Medical Association, America’s Health Insurance Plans, the National Association of Health Underwriters, and Consumers Union could all live with.

If the bill, succeeded, it would probably improve PPACA. If the bill failed because of opposition by Democrats, the Democrats would be demonstrating that it takes two parties to create political gridlock.

On the one hand: This kind of proposal probably falls under the category of fantasy. It’s hard to believe that Republicans would dare to be this bipartisan in public, or that the Democrats would trust the Republicans not to suddenly dump a pail of dishwater on their naive heads. 

On the other hand: I’m intrigued by the possibility that big campaign donors might actually influence Congress. Is it possible that major trade groups would actually like to improve PPACA at this point, not just leave it in such a state that it will destroy the U.S. health finance and health delivery systems as brutally as possible? 

On the third hand: Maybe the message of Superstorm Sandy is that the United States is a tired country. Maybe we’ll quietly let the raw, unfixed version of PPACA rot out the basement of the health care system because we’re just too sleepy and too crabby to work together on anything, even fixing some type in some obscure clause of a PPACA risk corridor program provision.

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