The Complex Mess of Health Insurance

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The Kaiser Family Foundation is one of the best sources of information on health care, and it recently convened some focus groups in the Midwest and Pennsylvania. These groups included people who received health insurance through an Obamacare exchange and who also voted for Donald Trump.

You can read about the results in an Op-Ed today by Drew Altman, Kaiser’s chief executive. It underscores how messy and uncertain the coming debate over Obamacare’s future will likely be.

I want to point out one theme that keeps popping up in Altman’s piece — and existed long before Obamcare: A lot of Americans are deeply frustrated by the logistical headaches built into our health care system.

I share their frustration, and I imagine most of you do, too. Just this week, a member of my family endured the Kafkaesque experience of being told that she needed to show up for an appointment even if she were no longer sick or face a penalty, thanks to insurance rules.

Strikingly, some of the Trump voters told Kaiser that they resented lower-income people who were enrolled in Medicaid, which they viewed as a better deal. Medicaid has its own complexities (and its own problems), but government-run programs do tend to be simpler than private ones. It’s true of Medicare, and it’s true of single-payer systems in other countries.

Obamacare looks the way it does because its designers wanted to cause the least possible disruption to the status quo while providing insurance to many more people. By that measure and others, as a new Times editorial notes the law has been a big success.

But if it’s too complicated to have assured its own political survival and Republicans really do repeal it — throwing millions of people off of health insurance — the next push for health reform should probably be simpler. It should probably revolve around expanding the government programs that already exist.

Wouldn’t that be ironic? The Republican passion for getting rid of Obamacare could ultimately lead to a bigger dose of Big Government.

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