Paul Krugman: How to Build on Obamacare

“If Mr. Trump really wanted to honor his campaign promises about improving health coverage…, there’s a lot he could do”:

How to Build on Obamacare, by Paul Krugman, NY Times: “Nobody knew that health care could be so complicated.” So declared Donald Trump three weeks before wimping out on his promise to repeal Obamacare. …

Actually, though, health care isn’t all that complicated. Basically, you need to induce people who don’t currently need medical treatment to pay the bills for those who do, with the promise that the favor will be returned if necessary.

Unfortunately, Republicans have spent eight years angrily denying that simple proposition. … But put politics aside…, what could be done to make health care work better…?

The Affordable Care Act deals with the fundamental issue of health care provision in two ways. More than half of the gains in coverage have come from expanding Medicaid… And that part of the program is working fine, except in Republican-controlled states that won’t let the federal government aid their residents.

But Medicaid only covers the lowest-income families. Above that level, the A.C.A. relies on private insurance companies, using a combination of regulations and subsidies to keep policies affordable. This has worked well in some places. …

Overall, however, too few healthy people have purchased insurance, despite the penalty for failing to sign up… As a result, some companies have pulled out of the market. And this has left some areas, especially rural counties in small states, with few or no insurers.

No, it’s not a “death spiral”… But the system could and should be improved. …

What about the problem of inadequate insurance industry competition? … At the very least, there ought to be public plans available in areas no private insurer wants to serve. There are other more technical things we should do too…

So if Mr. Trump really wanted to honor his campaign promises about improving health coverage…, there’s a lot he could do… And he would get plenty of cooperation from Democrats along the way.

Needless to say, I don’t expect to see that happen. …

And the tweeter-in-chief’s initial reaction to health care humiliation was, predictably, vindictive. He blamed Democrats, whom he never consulted, for Trumpcare’s political failure, predicted that “ObamaCare will explode,” and that when it does Democrats will “own it.” Since his own administration is responsible for administering the law, that sounds a lot like a promise to sabotage Americans’ health care and blame other people for the disaster.

The point, however, is that building on Obamacare wouldn’t be hard, and wouldn’t even be all that complicated.