Yesterday, I read 2 opposing views on the Obamacare/health care controversy. I am more a repair Obamacare person but I think both are well worth reading. So continuing the trend started yesterday on this blog, I will write about things I read in the Sunday paper.

We get 2 Sunday papers, the New York Times and the Philadelphia Inquirer. I discussed an article about retirement plans in the Times yesterday. Today it will be a pair of articles in the Inquirer about Obamacare (Affordable Care Act) .

Repair

The first is Commentary: GOP’s legal and political sabotage crippled Obamacare by Abbe R. Gluck. She argues that although Obamacare is not a perfect law, it would have provided heath care as planned excerpt that Congress sabotaged it rather than support it and repair as needed. Of the 2 articles this is the one closest to my view on Obamacare. We should just repair Obamacare.

Replace

The second is Commentary: Obamacare is unlikely to survive even if it is repaired by Josh Blackman. He argues that the Obamacare is so flawed and has so many problems it should be replaced. Even though I disagree with the conclusion I saw several points that I believed correct.

Death spiral

The repeal and replace crowd cites the death spiral and disaster of Obamacare.  The death spiral occurs when healthy folks are priced out of the heath insurance market.  That is, they think they will have relatively few healthcare expenses and be better off without insurance.  so they don’t but insurance.  After all if they get sick they can buy insurance then,  But sick people keep buying heath insurance because they figure they will have more than enough claims to justify the price.

So as a the health insurance companies insure more sick then healthy people prices go up.  As premiums go up fewer heathy people insure but the sick folks keep buying policies.  Each year it gets a bit worse as the portion of healthy people goes down and rates keep on increasing.  

So eventually only a few people have insurance and the plan to insure everyone becomes a total disaster.  You can see why they call it a death spiral.

Repair Obamacare, if we can

But as pointed out in the “repeal” article:

To paraphrase Mark Twain, reports of Obamacare’s death spiral have been greatly exaggerated. Indeed, there is not one Obamacare, but 51 separate markets. Some states are indeed thriving under the ACA. According to a 2016 McKinsey study, the individual marketplaces in Washington, California, and Vermont posted positive profit margins above 5 percent. However, insurers in 41 states lost money.

If there is a big problem in 41 markets, then 10 could be doing at least OK. Indeed several are doing well.

Would it be worth looking at the successful exchanges to see how they differ from the problem ones? Can these differences point us in the right direction for repairing the Affordable Care Act (aka Obamacare). Should we repair Obamacare or repeal and replace?