The Problem with the PPACA

What's the problem with the PPACA?

Part of getting to solutions is recognizing that Obama the politician wasn't and is not the root of the problem.

It's not Obama, it's the Obama Administration's ideology, the ideology that Rortybomb correctly identifies as "neoliberalism ascendent in the Democratic Party," that is the problem with these Democrats being in charge of negotiating policy with Republicans. Only when movement liberals can routinely recognize the agenda of our ideological opponents in the Democratic Party will we be able to clearly articulate an opposing agenda.

The individual named Barack Obama is not merely what opposes a policy framework that advances the interests of 99% of us. It's the fundamentally wrong, ideologically-based premises that form the Administration's policy framework that need to be discredited and overcome within the Democratic majority. A Third Way ideology which asserts that government assuring the proper level of political-economic power enjoyed by private insurance cartels, with their "expertise" in pricing risk and knowledge of how "markets" operate, is a necessary component of good public policy is the enemy of liberalism, just as surely as rightism is the enemy of liberalism.

So, start by pragmatically recognizing that, in the real world, the exorbitant prices that individuals are being coerced into paying for access to health care don't miraculously spring from a system that mostly resembles "market-oriented" health care economists' models, but are mostly the fiat decisions of large players in an industry that, like the "Too Big To Fail" financial interests, will simply use their power to determine those prices. Then, go about taking that power away from private insurers. The first step in defeating monopolists is to take away their ability to collude to fix prices and otherwise screw people, so the agenda for reforming the PPACA should start there, in my opinion.

We ought to be clear that the biggest flaw in the PPACA is the whole fiction of this system resembling some "marketplace," instead a recognition that truly realistic policy needs to tear down the fiefdoms of these latter-day, technocracy-friendly robber barons.

Here are some policy proposals designed to address that flaw:

    1) repeal the anti-trust exemption

    2) regulations on insurers' use of any premium dollars to market themselves and their messages to the public, or to otherwise influence the political process

    3) regulations on states' ability to contract Medicaid services to private insurers

    4) establishment of a single "provider network" per state (abolishing carriers' individually negotiated provider networks per policy), with insurance commissions' negotiations on provider payments to be conducted by all exchange participants in advance of premium calculations for 2015

    5) Medical Loss Ratio waiver power to be removed from HHS authority and waivers to be prohibited by statute, MLR set permanently at 94%/6%, establish permanent, transparent rules on expense/revenue classification, remove "activities to improve health care quality" as an MLR-exempt classification

    6) banning of insurer or third-party contracting of after-claim eligibility review processes, establishment of state agencies tasked with resolving eligibility disputes

    7) establishment of public claims-review agencies, with major reporting requirements, placing the burden of proof for claims payment denial or delay back on insurers

    8) prohibitions on the practice of providers' contracts with individuals prior to treatment that specify the liability of patients in the absence of timely insurer payments

    9) establishment of ratio of number of private carriers to states' non-Medicare eligible populations as a threshold for which Medicare eligibility age can be lowered, should carriers leave or threaten to leave states' markets

    10) repeal the special tax treatment of the Blues in IRS code, establish separate MLR that deals specifically with giant "non-profits" revenues

I would trade a maximum of 6 out of 10 of these reforms for the individual mandate delay, 10 out of 10 of them for the individual mandate repeal. An alliance of pro-reform liberal Democrats and anti-mandate Tea Party Republicans resembling  Amash-Conyers is politically possible at the moment.

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