I was at a conference yesterday which started with three speakers, one of whom was Andy Slavitt, the former acting head of CMS, and the others were my home state’s Commissioners of Health and Insurance. They each made one inaccurate, misleading or incomplete statement after another to defend the Affordable Care Act and deride current attempts to replace that law. This is the same nonsense that got us into this mess into the first place. You may recall an ex-President telling us that health insurance premiums would go down by 10% and everyone would be able to keep their doctors. We can’t make good policy in this hyper-partisan atmosphere that refuses to honestly acknowledge the difficult facts and choices surrounding health care. Slavitt said that 23 million people would lose coverage under the proposed replacement of the ACA, without mentioning that the Office of the Actuary, which reported to him and which has a far better record on predicting the effects of health reform than the CBO does, had produced a lower estimate of 13 million people. He said that most plans actually made money on their exchange business, which is a flat-out lie. He claimed that the law was responsible for restraining spending growth, but the gap between health spending trends and increases in economic and personal income remains substantial. And he and the other speakers tried to blame the problems of the exchanges on the new Administration, which is absurd. Exactly as predicted by many experts, the exchanges imploded within five years after starting because of dreadful design and a refusal to acknowledge basic truths about human economic behavior.
Perhaps most offensive to me was the Minnesota Health Commissioner talking about these people who might lose Medicaid coverage, partly because of “onerous” work requirements being proposed. What universe do these people live in where it is okay to give tens of millions of people gold-plated, basically cost-free services paid for by hard-working taxpayers, who generally have much worse and more expensive health care coverage; but it is not okay to suggest that the vast majority of these Medicaid recipients who are perfectly capable of working, should have to do so to get Medicaid and should have to contribute more for that coverage. What is truly onerous is to have morons like that Commissioner in charge of anything. We have very substantial problems relating to our health system, which contribute to an even worse fiscal situation for the country. We have $20 trillion in federal debt, and we are adding to it every year. We have states on the verge of bankruptcy. Spending on health care, especially Medicaid, is a leading contributor, along with ludicrous public employee pensions, to this debt and spending crisis. We can’t afford the current health system, especially as it was reconfigured by the reform law. Lying about the impact of that law is not going to help design fixes to the system. People have to be more responsible for their health and health care, and that isn’t going to happen if they have no disincentives for unhelpful behavior. And we need to end our fixation on health insurance for everyone as the solution; that contributes to a complex and expensive system which eats up dollars in administration and profit. I can rant about this all I want; unless policymakers truly commit to changing their behavior, things aren’t going to get better.