Eat the elephant one bite at a time
Large objectives can be tackled. It’s easy if you break it down into smaller tasks. The same applies to changing our approach to the “Affordable” Care Act a/k/a Obamacare. Did anyone really think we could eat the elephant in one bite?
First, take a good look at the elephant
How big is it? How tall, how wide, How complex? If you want to read the law, here are some links:
- Full Text of the Affordable Care Act and Reconciliation Act (PDF – 2.6 MB) This is not the official version, and [the government provided it for your convenience.
- Certified full-text version: Affordable Care Act (PDF – 2.41 MB).
- Certified full-text version: Reconciliation Act (PDF – 257 KB). This is the funding and taxation side of it.
- Wikipedia article. Very long, extremely detailed. There are 475 footnotes! There are referenced articles on every nuance you can imagine.
- Public Law 111–148 after consolidating the amendments made by PPACA Title X and by HCERA. 906 pages of bedtime reading.
- 2100 listings of Rules, Notices of Rules and Proposed Rules. 1,220 Notices, 372 Rules, 317 Proposed Rules, and 204 Presidential Documents. And these are out of 73 Agencies.
Repeal and Replace was a silly notion
You might be able to eat the elephant, but not in one bite. Sure, it sounded good on the campaign trails. But just take a look at the resources linked above and tell me that a full repeal could be made. Read the Wikipedia article in #4 above, or review the listings in #6 above and see how many agencies, how many parts of American life and business, and how many “points to ponder” exist in this behemoth.
Eat the elephant or just make sure it doesn’t eat us?
We must figure all the major pieces that exist on the elephant and then determine where to start. The goal must be determined and it is not to eat the entire elephant, but rather to end up with satisfaction to the palate.
The goal really is not to eat the elephant, but simply to tame it. I suggest that there has been scant attention paid to the real problems that Obamacare only exacerbated. Just some:
- Our (the country’s) problem is not healthcare, but rather health. Large segments of our population are unhealthy in many ways and from many causes. Obesity estimates are in the range of 30% overall and higher in certain populations. Most families have been touched by heart-attacks, cancer, liver disease, and more. Drug usage and the longterm effects of chronic drug usage are growing. Yet there is little attention in the “reforms” to addressing fundamental health issues.
- Little attention was given to healthcare delivery. What you hear touted is that with Obamacare fewer people will use the emergency rooms for basic care. Has that happened? What about rural areas? I don’t hear about clinics popping up in places like Ozona, Texas.
- Was Obamacare anything more than a financing scheme that pulled us closer to a single-payer system but still on the backs of the insurance companies? You can find plenty of stories of care/coverage being but off a the behest of the insurance company that determines “you are well enough.” Decisions are made by an insurance company bureaucrat about what you need or what they will cover. I fear the day that bureaucrat is working directly for the government.
It can be argued that Obamacare has done some great good, but even strong partisans agree to a large extent that many problems remain. Repeal and Replace was a silly notion. There are good parts to keep and bad parts to fix. It will take a bipartisan approach infused with a lot of statesmanship that has been lacking.
Congress will have to figure out a way to do its duty and the erasure of rigid party lines and dogma must be the first step. Otherwise, the elephant will stomp on us all.