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Obamacare Is Still Failing

Walter Russell Mead

It’s worth remembering amid the brouhaha over the GOP’s tumultuous efforts to come up with a replacement: Obamacare still isn’t working. Many of its most valuable achievements are not sustainable. The Wall Street Journal reports:

Aetna Inc. said it will pull out of the Affordable Care Act exchanges in Delaware and Nebraska next year, confirming that the insurer will exit all of the marketplaces where it currently sells plans. […]

Aetna said its individual plans are projected to lose more than $200 million this year, and “those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration.” The insurer said that “at this time [we] have completely exited the exchanges.”

In any case, the thing that is slowly killing Obamacare, with or without Republican help, is the same thing that is making it so hard for the GOP to come up with an alternative: American health care costs too much. Solving this problem isn’t just about litigating the merits of Obamacare or Trumpcare; it’s about ensuring that the American people have access to the health care they want and need while keeping the country solvent.

We can’t do this all at once by some mighty government fiat—or, for that matter, through a blind faith in private markets. It took two generations for us to work ourselves into our present mess, and it will take time to work our way back to a sane and sustainable system.

Some promising areas for future policy innovation include: regulatory reforms that encourage disruptive forms of health care delivery, tort reform that eliminates the distortions that “defensive medicine” imposes on the system, and efforts to “push competencies down”—with help from computer assisted diagnostics, for example, registered nurses (RNs) can do more things that only doctors could do well in the past, and licensed practical nurses (LPNs) can do things that used to require RNs.

Policymakers should also study expanding immigration preferences qualified medical personnel: We don’t need more immigrants who compete with unskilled American workers at the low end of the job market, but we could definitely use well-educated physicians to help lower costs for Americans in all income brackets.

The economic unsustainability of the current American health care delivery system isn’t just a menace to the federal budget, and a menace to poor people who can’t get good coverage: it is a threat to public health. The NIH and other research institutions should study health care delivery systems with the same focus and energy they bring to the quest for new drugs and other technologies—in the long run, reducing costs in a sustainable way will save as many lives as almost any new drug.

Until we make care less expensive, we will be stuck in the same debate we are having now, with each party offering plans that distribute resources in different ways but that leave too many people with inadequate coverage or without coverage at all.

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