Neptic.com/blog

Government Shutdown, Budget, Debt Ceiling, and ObamaCare

Disclaimer These are just my current opinions based on the information I have. I am entitled to change them as I discover or understand more.

Summary

The Republicans think they didn't get enough say in the health care reform bill and that the Democrats ignore them when they want to discuss improvements. They say the Affordable Care Act (ACA), a.k.a. "ObamaCare", will make and is already making things worse. Therefore it should be de-funded or at least postponed to give Congress a chance to improve it. Since the Democrats won't listen the Republicans are trying to block budget bills, and presumably will try to block raising the debt ceiling later this month, until they can force some negotiation.

The Democrats refuse to negotiate, saying the Republicans are not allowed to hold the government or the economy hostage for an ideological battle. The bad part that I agree with is the constant "ruling by crisis" since it hurts confidence in government policies and thus hurts the economy. But they hate what the Democrats have done the past several years and are fighting it in any way they can while the Democrats try to ignore them. So this is a fair way to yell.

It also appears that the Republicans have offered to negotiate with four different requests of lessening intensity all without Democrat response. First, de-fund ObamaCare. Second, just delay implementation a year to let Congress improve it. Third, give individuals the same exemption given to businesses and Congress members by delaying the individual mandate a year. Fourth, let's just talk about anything!

Budget

While blocking the spending bill causes a partial government shutdown, it does not block ObamaCare's funding sources so it will continue to operate.

A related tangent: we really need a balanced budget. Obama brags about how deficits have reduced so much during his reign, but the deficits are still there, meaning we're still spending more money than we're collecting. Untenable. As strong as America is, we have seen nations and empires collapse all throughout history. We will eventually be destroyed if we cannot control our overspending.

Debt Ceiling

We will probably get to this fight, just like late 2011. My opinion is simple: either leave the debt ceiling exactly where it is or repeal it altogether.

What's the point of a debt limit if we just raise it every time we get close to it? It does not encourage any frugality. We either need to force ourselves to stop spending or we should be honest about our inability to limit debt by this failed mechanism.

Obama said raising the debt ceiling is routine, adds no debt, and allows us to pay the bills we already have.

ObamaCare

We need health care reform. People go without care, people are decimated by paying for care, and the cost of care, as paid by both Americans and the government, is too high. I am in favor of health care reform.

I do not know enough specifics about ObamaCare to say what is good and bad about it, but there is certainly a lot of good here. Congress should work to improve it, not to repeal or de-fund it.

That being said, Obama is a liar (or ignoramus) when he said people will be able to keep their current plans and doctors. The cost of insurance has to go up to cover all those people whom insurers can no longer reject. Or insurance will cover less, so the cost to consumers goes up. Either way people will have to pay more. For some, this will mean they can't keep their current plans. Plans might also reduce what doctors they allow. Either from that, or from losing their plan they might not be able to keep their beloved doctor either.

I'm a middle class guy. But I already have health coverage through my employer, so ObamaCare isn't helping me, rather it's making me pay more. For all Obama talks about helping the middle class, he's certainly not helping me.

If it helps the overall economy, the overall government budget, the American people overall, then I can live with it. Just tell the truth about this.

Healthcare Ideas

Note that ObamaCare does not force insurance on undocumented immigrants. So with EMTALA we'll still have uninsured people flooding the Emergency Departments to get free care for common issues, or expensive care that they'll never be able to pay for.

So why don't we modify EMTALA. If an issue is non-emergent, give hospitals the flexibility to send the patient to a less expensive facility, like an Urgent Care or a family physician. Maybe even give the hospitals the option to refuse treatment of uninsured individuals if they can't pay upfront or provide adequate proof of ability to pay (like a credit score check). Reducing the money bleeding in the ED will change it from a loss leader to a financially viable department and take away the excuse hospitals give about needing to overcharge everyone else to account for the uninsured. So long as undocumented immigrants can get health insurance through exchanges like everyone else then it's fair.

Take away the charge master. Make it illegal. Those prices are based on nothing. Instead, all prices should be negotiated as percent markups over the Medicare price.

Mandate telling patients a cost upfront. The cost could be given as an upper limit or a range based on potential complications. If the procedure performed is the one estimated, then the hospital can't charge more than the upper limit they gave. If there's some unforeseen complication then of course they can do a more complicated procedure. But for the most part customers would have an idea of the cost before going in, including their out-of-pocket (co-pay, coinsurance, deductible, lifetime limit). If hospitals try to hedge their bets with higher estimated maximums then they'll look bad compared to other hospitals that might hedge their bet slightly less. Making the price visible helps bring market forces to bear.