Paul L. Caron

Monday, April 7, 2014

Gamage Presents Should Risk Adjustment Become the Heart of Obamacare? Today at Harvard

Gamage (2014)David Gamage (UC-Berkeley) presents The Evolution of Health Care Reform: Should Risk Adjustment Become the Heart of Obamacare? at Harvard today as part of its Health Law Policy, Biotechnology, and Bioethics Workshop Series:

This Essay explores how the regulatory framework of Obamacare might evolve over the coming years. The Essay analyzes the ways in which Obamacare’s risk-adjustment-related provisions are becoming increasingly central. This Essay further ponders whether an expanded approach to risk adjustment might be a better model for guiding further reforms to Obamacare’s framework, especially in light of political constraints. In particular, this Essay explains how an expanded approach to risk adjustment might replace the tax penalty of the individual mandate.

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From the paper: "In effect, the markets in Obamacare may operate as little more than an excessively complicated and costly form of a single‐payer system."

This would displease single-payer advocates only if it occurred so quickly that voters would see a return to the prior system as possible, but that's exactly what is happening.

I believe that the primary objective of the law was the slow-motion destruction of the markets for private insurance: first the individual market, then the employer market. I don't believe that the writers of the law ever expected the speed and magnitude of the collapse of Obamacare. Its rapid collapse has left voters leery of government solutions in health care and nearly ready to demand a return to the old system with all its flaws.

Democrats wanted government-directed health care in the worst way, and that's how they got it. The proliferation of delaying tactics by the Administration only aggravate the long-term troubles of Obamacare, but that doesn't matter to single-payer advocates. The name of their game is to keep Obamacare alive until the only way out is forward to single payer. I don't believe it will work, but I admire their dedication to their cause.

The fundamental economic problem is that the middle class does not want to pay what it will cost for the kind of health care we want. No program can square that circle.

Posted by: AMTbuff | Apr 7, 2014 1:42:09 PM