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Opposition to Obamacare is stronger than ever, but critics of the law will need to unite around an alternative if they want to move the nation’s health care system in a free market direction. In Overcoming Obamacare, the Washington Examiner’s Philip Klein, one of the leading conservative health care writers, takes readers inside the fierce debate on the right on how to overhaul the health care system in the wake of Obamacare. Drawing on eight years of experience reporting on the issue, dozens of interviews with prominent health policy experts, and conversations with Republican political leaders including Bobby Jindal and Paul Ryan, Klein articulates a free market vision for health care and presents three competing paths to getting there. Whether you’re a conservative fighting to repeal Obamacare or a liberal wondering how Republicans may go about unraveling it, this book is a must read.
- Sales Rank: #1163043 in Books
- Published on: 2015-01-06
- Original language: English
- Number of items: 1
- Dimensions: 8.50" h x .26" w x 5.50" l, .31 pounds
- Binding: Paperback
- 112 pages
About the Author
Philip Klein is commentary editor of the Washington Examiner, where he writes about domestic politics and policy and runs the opinion section. He has emerged as one of the leading voices on health care policy on the right. His work has been cited by a diverse spectrum of media outlets, from syndicated talk radio host Mark Levin and columnist Michelle Malkin to publications including the Wall Street Journal, the New York Times, and the Washington Post, among many others. He formerly served as Washington correspondent for the American Spectator and a financial reporter for Reuters news service. He is a graduate of George Washington University, where he earned degrees in history and economics, and also holds a master’s degree in journalism from Columbia University. He is the author of Conservative Survival in the Romney Era.
Most helpful customer reviews
9 of 10 people found the following review helpful.
Short on detail and analysis; long on ideology. Overall a disappointment
By Paul Albert
Mr. Klein's book was a disappointment as it mostly consists of a rehashing of conservative talking points: basically Obamacare is very bad and we would make things better if only given the chance. There is no depth here, no analysis of the problems in our group and individual markets, and little discussion of cost drivers aside from the tried and true malpractice costs.
Full disclosure. I am a reluctant ACA supporter. In my view the only thing worse than the ACA is no ACA. It has solved some problems, extended care to millions, and also attempts to make a start on addressing cost issues through some of the rules on readmissions, creation of ACOs, etc. I've read many books on health care/insurance issues, and have a pretty good understanding of how other countries long ago attacked and solved the problems (yes, it is an ongoing battle everywhere) so I looked forward to a conservative slant on solving the complicated, costly maze of health insurance in the United States.
The book is short on specifics. But one noteworthy proposal by Mr Klein had me shaking my head in agreement and that was to open up the individual markets to anybody with an employer-based plan. Employer-based plans enjoy tax free treatment both on the employer and employee side. Employees have little to no choice in a plan, the employer picks it for them. Allowing everybody to shop for their coverage, requiring employers to contribute to an HSA for the employee (yes HSA rules need to be changed), would increase choice and competition in the markets. It seems this should be a targeted improvement to the ACA but conservatives have been too hung up on slaying the beast rather than solving problems. Later in the book, Mr Klein pretty much shoots down this idea as being too disruptive when he discusses Gov. Bobby Jindel's ACA replacement proposal.
Mr Klein touches on all the familiar talking points. The ACA is a government takeover. Curiously he never mentions the fact the ACA was designed to work at the state level with each state taking responsibility for its own rules and exchanges. Typically this is a model that conservatives would rally around but instead governors and legislators deferred to the federal exchange.
Mr Klein mentions that insurance should be able to sold across state lines. The ACA specifically allows states to enter into agreements to form compacts allowing multi-state availability of plan.
Mr Klein blames the ACA on making insurance more expensive, decreasing choice with more limited networks, and forcing people to buy something they don't want. He documents polls declaring the vast majority of people don't like the ACA but then mentions how it only addresses a small subset of the population, individuals, and especially those individuals who had pre-existing conditions (aka Medical History) and could not obtain insurance.
Now this makes no sense because if the ACA only really affects a small segment of the population, then why is it so unpopular? Could it be politics? Why does anybody on Medicare hate the ACA? It doesn't affect them, but perhaps they don't like the 'government giveaway', which is pretty rich considering that Medicare is the ultimate subsidized, single-payer system. Those with employer-based plans are pretty much unaffected, that is if your plan had been somewhat comprehensive to begin with.
The reality is we've all been suffering with ever increasing premiums, higher co-pays, higher deductibles, and more limited networks (lack of choice) for the past 20 years and this is in the group markets where most of us get our insurance via our employer. Now the ACA has become an easy scapegoat for these continuing trends.
One of Mr Klein's examples of premium increase in also on the bogus side. He writes that premiums for the youngest, healthiest segment have risen to offset the cost of insuring the older groups. There is some truth to this in the individual markets but Mr Klein compares apples to oranges. He compares the cost of an average individual policy in NY in 2012 ($4260/yr) vs Pennsylvania ($2088). Pre-ACA, Pennsylvania did not have 'must issue' rules, meaning anybody could be turned down for insurance. Of course, the Pennsylvania rates were low, they could cherry-pick customers. NY had must-issue rules but without a mandate, this sent the individual market into a death spiral. The individual market crashed from over a million customers to around 35,000. Neither state had a solution. If you had any kind of medical history and needed an individual policy in Pennsylvania then you were out of luck. In NY, you had to pay absurd rates.
The ACA has done away with community premium ratings. Younger employees in my company now pay less, in some cases far less, with our current policy. The older groups pay somewhat more, which is what Mr Klein proposes, except that he'd like older groups to pay even more than they are now. Cost of my current coverage is about $27,000/year. I'm 59 years old. How much more would he like me to pay?
Mr Klein says that the group markets work because of the larger pools which share risk. However, a robust individual market also shares risk and is larger than any small group that many of us belong to.
There is much discussion of subsidies and how conservative plans will replace those with tax credits and/or deductions. Most of the numbers cited are laughably small in relation to the cost of insurance so it is difficult to imagine how either a credit or deduction would help people afford insurance. Also, you can't pay an insurance bill with a tax credit that you won't see for a year or more.
I always shake my head in wonder at how conservatives have run away from every plan they had ever suggested prior to the ACA as subsidies and mandates were always part of their proposals. Who can forget the spectacle of Mitt Romney trying to disavow any responsibility for RomneyCare.
One thing about subsidies is at least there is a modicum of personal responsibility. Those receiving subsidies for the most part pay a portion of premium as well as co-pays and deductibles, etc. This should warm a conservative's heart. Because of subsidies and the increase in the number of insured here in New Jersey, the upcoming state budget reduces charity care payments to hospitals by about $150 million dollars. And this is a bad thing?
Mr Klein does have some moments of refreshing honesty. Early on he writes that Republicans ceded the health care/insurance issue after they failed to address it after defeating the Clinton initiative and gaining the White House. Beyond that, Republicans have had five years to come up with a credible detailed plan to fix the ACA but have offered nothing but generalities.
In the old days Congress would fight and claw at each other about major legislation. But once it passed there was general agreement to address problems and make improvements. This included the common-sense exercise of fixing typos or making clarifications. This is how the question of subsidies brought up in the absurd King vs. Burwell case would have been addressed. There is nobody in Washington who seriously believes that Congress meant to deny subsidies to people living in states covered under a federal exchange. Yet here we are.
One of the failings of the ACA is that it did little to deal with the cost side. What is the solution to drug companies being able to charge whatever they feel like, no matter how outrageous, for a drug? The excuse is always that if we didn't pay the extortionist rates then the drug companies and medical device manufacturers would just fold up shop. But they seem to do quite well in the rest of the world. Must we subsidize their profits? How about allowing Medicare to negotiate drug prices. How about allowing Americans the freedom to import drugs from Canada? Never a mention.
How about creative ideas to relieve insurance companies of the burden of the very sick. Instead of creating a mish mosh of high risk pools why not just have the federal government be the reinsurer? Reinsurance is common practice in the private sector.
This is a short, easy read and there are lots of footnotes and sources to follow up on. It is not a serious attempt to delve into the problems and fixes for our health care/insurance mess. This book is really more about implementing legislation to satisfy the ideological leanings of the right. As Bobby Jindel said, “It is not about covering the most people, it is all about reducing costs.” Readers are expected to take it on faith that the conservative plans outlined in this book will solve any problem other than ridding them of the dread Obamacare.
Our 'system' is beset by mind-numbing complexity, plus a lack of transparency and competition. Access to care is often determined by the luck of the draw. Do you work for a company with 'good' insurance? How many insurance companies have decided to operate in your state and what do they offer? It is easy to throw rocks and break windows. It is much harder to solve problems that have developed over decades, all intertwined with another. Ideology does not solve problems but that seems to be the driving force behind this book and current conservative policies.
4 of 4 people found the following review helpful.
Just What I have been looking for.
By John C. Becker
I bought this book to get some background on alternative approaches to the Patient Protection and Affordable Care Act. This book does that in a mildly partisan way. I also appreciate the degree of detail and the discussion of strategy that the book provides. I have recommended it to others who are interested in this issue as I believe this is a conversation that is way over due.
3 of 3 people found the following review helpful.
A must-read for anyone interested in conservative alternatives to Obamacare
By Patrick
A clear and concise summary of various proposals for implementing free-market reforms for healthcare in the post-ACA political landscape. What I appreciated the most about this book is that it summarizes the political obstacles each approach would need to overcome in order to be implemented.
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