No doubt you have butterflies just thinking about Thursday’s first GOP debate.
I know I do.
Center stage will be the man who needs no further introduction. And the big topic will be — are you ready for it? — the Affordable Care Act. Can you hardly wait? I know I can’t.
Any fresh opportunity to talk about repealing and replacing Obamacare is like dipping into a warm bath. Toss in a breathtaking view and the smell of fresh-cut grass and — pinch me.
But didn’t we just do this not long ago? With two Supreme Court rulings in favor of the ACA and five years of entrenchment, can there really be anything more to say? You bet. In fact, you can say that only 30 percent of enrollees in Obamacare are satisfied, according to a recent survey by the Deloitte Center for Health Solutions.
And Donald Trump had this to say to CNN’s Dana Bash: “Repeal and replace with something terrific.” Well, that’s helpful. Because all along we’ve wondered what Republicans would replace the ACA with, exactly.
This was quintessential Trump — and is the secret to his success. He’ll do GREAT things, TERRIFIC things! Everybody LOVES him. Because he’s the GREATEST!
He says such things so often with such certitude that people begin to believe him — because it just feels so GREAT to be so POSITIVE and, yes, yes, yes! We’ll have what he’s having.
But is America ready to take him seriously? If some have found his can-do attitude contagious, others may be awaiting further policy illumination during Thursday night’s debate. Don’t count on it. It seems highly unlikely that Trump has binders full of policies. Even better, he has people. He has fellow billionaire and business magnate Carl Icahn, for instance.
“I’d say Carl, congratulations, handle China. I’d get other guys like Carl. I’d say, good luck, here’s Japan. Believe me, we will do so well. We will make so much.”
It’s not clear yet whom he’d tap to “handle” Obamacare, but for a man consistently focused on extracting the United States from its $18.6 trillion debt (year-end estimate), returning the nation’s health care to a competitive, free market model is on his To-Do list. As well as of every single Republican candidate.
Cutting the debt means cutting spending, which brings us back to the ACA, which, despite its goal of reducing costs, hasn’t. In fact, costs are rising faster than inflation, thanks in part to a large, aging population — and the simple fact that more is being done. Meanwhile, insurance rates, which President Obama promised would decrease by $2,500 per year, are poised to spike by as much as 20 percent to 40 percent in 2016. It turns out that people were sicker than anticipated.
But is repeal-and-replace really an option? The disruption across the board would be significant, says Dr. Delos Cosgrove, CEO of The Cleveland Clinic. Cosgrove will join me Wednesday in Cleveland for a pre-debate, Washington Post panel I’m moderating about the ACA in 2016. Other panelists are Michael Carvin, the plaintiff’s attorney who argued both challenges to the ACA before the U.S. Supreme Court; and lawyer and Republican political consultant Benjamin Ginsberg. The program, including two other panels, will be live-streamed on the Washington Post website beginning at 6 p.m.
Although Cosgrove has adapted his clinic to the ACA and cites overall improvements in terms of health care, his diagnosis and prognosis doesn’t make one race to peal the bells. Health care’s total bill will continue to rise, he predicts, and there are only two ways to control cost: Efficiency of care, which has been a major thrust of the ACA; and a decrease in the incidence of chronic disease such as cancer, diabetes and obesity.
But prevention requires behavior modification on a massive scale, doesn’t it? Yes, says Cosgrove, and “the private sector will have to lead the way by pushing people into wellness.” His clinic, for example, doesn’t hire smokers, which has had an influence on the community, where smoking has decreased.
There may be other confounding factors that led to this decrease, but you get his point. We’re talking about living healthier lives to avoid disease so that our health care and insurance costs will go down or at least stabilize. This sounds rational but not quick. And it doesn’t consider the confounding-est factor of all — human beings.
Since people seem unable to resist deliciousness, how do you get them to eat healthier — and less? Tune in for answers.
I’ll be terrific.
Kathleen Parker is a columnist for The Washington Post.