Transcending ObamaCare

To rise about or go beyond the limits of; to outdo or exceed in excellence.

Definition, To transcend

I have spent the morning trying to get my arms around Avik Roy’s “Transcending ObamaCare: A Patient-Centered Plan for Near-Universal Coverage and Permanent Fiscal Coverage, “ a white paper published by the Manhattan Institute where Roy is a senior fellow.

I have not yet grasped the full sweep of Roy’s proposal. Small wonder. The executive summary is 11 pages, and the report itself is 61 pages.

In essence, as its title suggests, “Transcending ObamaCare” goes beyond ObamaCare. It does not suggest repealing the law but in gutting it and restructuring it.

Roy says ObamaCare has four major problems:

One, it makes health insurance unaffordable for middle-income Americans.

Two, it causes long-term fiscal instability, i.e. cost overruns, for the U.S. budget.

Three, it dramatically expands Medicaid, with poorest outcomes of any health care system in the industrialized world.

Four, it spends over $2 trillion in the next decade but leaves 23 million lawful U.S. residents without insurance.

Roy proposes “ The Universal Exchange Plan,” or simply “The Plan.”

The “Plan” does not call for a full or formal repeal of the ACA. It has roots in the marketplace plans of two wealthy nations – Switzerland and Singapore.

These two countries have market-oriented plans offering universal coverage at a fraction of U.S. costs. Switzerland spends 45% of what we do and Singapore 25%. Switzerland fully subsidizes low income individuals, moderately subsidizes middle-income individuals, and gives no subsidies to high income individuals. Singapore funds catastrophic coverage for all citizens and reroutes a portion of payroll taxes through health savings accounts to pay for routine medical expenses.

The key reforms for Avik Roy’a “plan” include.

1. Repeals ACA individual and employer mandates.

2. Frees exchanges from most federal regulations.

3. Combats hospital monopolies.

4. Moves Medicaid enrollees and retirees into reformed exchanges.

Avik Roy projects his plan will:

1. Reduce 30 year budget debt by $8 trillion.

2. Reduce 3o year spending by $2.5 trillion.

3. Make Medicare Trust Fund permanently solvent.

4. Reduce private sector premiums.

5. For Medicaid population, improve public access by 98% and medical productivity by 159%.

6. By 2025, increase coverage by 12.1 million above ACA levels.

I do not know if “The Plan” will work as proposed, if it will be acceptable politically for the next administration or for the public at large. But Avik Roy impresses me. Liberals consider him “thoughtful;” he is author of “The Apothecary,” Forbes widely read health policy blog; he writes regularly for The National Review and a number of other major publications, and he was educated in molecular biology at MIT and in medicine at Yale University School of Medicine.