Recently, I threw out some ideas for how candidates could show that they have created serious alternatives to the Patient Protection and Affordable Care Act (PPACA). (Or, if they like PPACA: How they can show they have well-thought-out reasons for leaving PPACA alone.)

See also: On the Third Hand: A PPACA replacer screener

It seems as if certain candidates (Hillary Clinton) have a tendency to accuse opponents of proposing unrealistic health system change proposals.

On the one hand, in general, I think the biggest flaw in political candidates’ health policy proposals is that they tend to talk mainly about the nice, happy parts of their proposals, and, possibly, about the increases in taxes and penalties for billionaires. They tend to ignore the costs, regulatory burdens and limits on choice that might be imposed by their proposals.

Sanders loves to talk about providing Medicare for all. He doesn’t talk about the section of his old American Health Security Act bills in which he proposed handling budget overruns by adjusting physician reimbursement rates every quarter. Somehow, the quarterly physician pay cut mechanism is not the first thing he brings up when he’s campaigning.

On the other hand, candidates for office ought to have some room to paint themselves and their proposals in the best possible light.

Every possible proposal will come to life with known weaknesses, and surprises can capsize any possible plan.

One test for a proposal might be: If candidates describe their proposals in the most positive terms that any voter can stomach, do voters actually like those rose-colored glasses versions of the candidates’ health policy worlds?

On the third hand, some candidates may bring out what look like skimpy, unserious proposals because they are seriously skeptical about how much the government can or should do to fill health access gaps.

Some candidates might argue that government intervention in health care generally increases the cost of health care, decreases flexibility, or leads to financial pressures that reduce what consumers can spend on other things they like.

If candidates have the guts to talk about their views on the limits of the government’s role in health care, this may sharply cut down on the amount of impact analysis they have to do to show that they’re serious.

If they think the percentage of people with health insurance is of no real concern to the federal government, why should they have to estimate how their proposals might affect the uninsured rate?

On the fourth hand, harsh, detailed scrutiny of health policy proposals is clearly a good thing.

Even the most ardent supporter of the goals and general design of the Patient Protection and Affordable Care Act (PPACA) might wish the legislation that created the law had gone through a longer, more orderly review process.

The preambles to some Internal Revenue Service (IRS) PPACA implementation regulations seem to convey, in regulatory code, “Please don’t blame us for these bizarre regulations. We’re just implementing what’s in the statute.”

On the fifth hand, candidates ought to show some humility in this area. The other candidates’ proposals may be absurd, but, chances are, there’s something absurd in their own proposals too.

A pure single-payer proposal is based on bizarre assumptions about the ethics and efficiency of the government.

A pure free-market proposal is based on bizarre assumptions about whether it’s OK to sometimes let broke patients die on the sidewalk in front of the hospital.

Every proposal in between is based on the Rube Goldberg gears and springs needed to keep the health care finance ball up in the air between those two opposing positions.

The strangest thing of all is that, somehow, much of the time, we muddle through and do get health care, in spite of how bizarre the effort to reconcile the need for health care with the difficulty of paying for health care often is.

See also:

How might ‘Berniecare’ work?

Sally Pipes proposes PPACA replacement plan

   

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