David Brooks thinks that the ACA should be replaced with … lots of stuff already in the ACA

In a column about the Supreme Court’s health care decision today, David Brooks offers up a series of recommendations about how to improve the nation’s health care system that he’s positive are not already in the Affordable Care Act (ACA). It’s worth quoting at length because it’s so revealing:

“Crucially, we haven’t addressed the structural perversities that are driving the health care system to bankruptcy. Obamacare or no Obamacare, American health care is still distorted by the fee-for-service system that rewards quantity over quality and creates a gigantic incentive for inefficiency and waste. Obamacare or no Obamacare, the system is still distorted by the tax exclusion for employer-provided plans that prevents transparency, hides the relationship between cost and value and encourages overspending. … Republicans tend to believe that the perverse incentives can only be corrected if we repeal Obamacare and move to a defined-benefit plan — if we get rid of the employer tax credit and give people subsidies to select their own plans within regulated markets.”

Let’s take these in turn:

Obamacare or no Obamacare, American health care is still distorted by the fee-for-service system that rewards quantity over quality … inefficiency and waste

Actually, no. The ACA has introduced pretty sweeping reforms to payment delivery; see the Independent Payments Advisory Board (IPAB), created precisely to engage the issues Brooks raises.

Obamacare or no Obamacare, the system is still distorted by the tax exclusion for employer-provided plans that prevents transparency…

Again, no. The ACA does indeed limit the value of this tax exclusion over time.

Republicans tend to believe that the perverse incentives can only be corrected if we repeal Obamacare and move to a defined-benefit plan — if we get rid of the employer tax credit and give people subsidies to select their own plans within regulated markets

Actually, no, no and no.

‘Move to defined-benefit plans?’ What this bit of buzz-speak means in practice is simply exposing a higher share of peoples’ incomes to health insurance premiums over time. Like when exchange subsidies don’t keep up with projected health care costs (unless these costs slow). Just like in the ACA (which could actually even shift a higher share of premium costs onto exchange enrollees).

‘Get rid of the employer tax credit?’ I think he means the tax exclusion referenced above, but, if not, there is an employer tax credit in the ACA … that the ACA “gets rid of” in two years when the exchanges are up and running. And, if he does mean the tax exclusion, see above.

‘Give people subsidies to select their own plans within regulated markets?’ Seriously? Subsidies? Yup, in the ACA (do I really need to link to anything here?). ‘Regulated markets?’ Yup, also known as “exchanges.”

Health care is complicated and all, but this is amazing stuff. I know conservative commentators think it’s just a talking point, but the ACA really, really does reflect deep compromise relative to what many liberals think that health reform should look like; and it really does incorporate many ideas put forward by conservative health reformers over the years.

And to be clear, I’m not a huge fan of many of these compromises or conservative reform ideas—but they’re in the bill, and one should not be allowed to pretend otherwise.

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  • http://wetcasements.wordpress.com/ wetcasements

    David Brooks is as stupid as he is wealthy.

  • DeeinColumbiaMD

    Conservatives after a time force themselves into believing their own talking points it’s how they live with what sane individuals would be ashamed of. However, they are not alone in this practice Thomas Friedman practices it on a regular basis when he clamors for this centrist leader who sounds an awful lot like the one we have, to offer solutions like the ones we got and demands a third party that is uncannily like the Democrats. So Brooks is not alone in his delusion perhaps there is something in the water over there in the NYT.

  • MFL

    This is a great blog piece! David Brooks keeps on going in his next column… http://www.nytimes.com/2012/07/03/opinion/brooks-a-choice-not-a-whine.html?hp

    In number two, he says, “Americans should be strongly encouraged to buy continuous coverage over their adulthood. Then insurance companies would not be permitted to jack up their premiums if a member of their family develops a costly condition.” If I’m not mistaken, that is the premise of the mandate?

  • Jfigart

    EPI and many others are trying to making logical arguements and dispell myths regarding the ACA.  The conservative point is to create a fear factor in the public about ACA…what is does…and doesn’t do.  The end result will be the will have a plank to further demonize Obama with the hope of the Republicans regaining the Senate and holding the House in the 2012 election….perhaps the White House…and will repeal and replace ACA with an ACA clone (as ACA is significantly a conservative approach to health care and health insurance reform) but with different talking points.  The difference is the new ACA will have no Medicaid expansion…and therefore expanding coverage to only about 3 million…

    American voters in mass do not study issues…they see TV ads….and make decisions from ads.   If you want to keep ACA….then we have to make ads that promote the benefits…and give up on comparing politically motivated articles with the truth. 

    This is not about truth…it is about political public relations. 

  • http://profile.yahoo.com/V3ZOC2SGF7M5R6XJDLD4V2PEZ4 Franco

    Brooks is a joke. His role is to brainwash people like others in the media who are paid off by corporations. While the ACA is certainly being misrepresented for political reasons, the EPI is also exaggerating its benefits while ignoring the fact that it does nothing to address the real problems in US healthcare. This is disappointing and worrisome.

    I would suggest anyone who wants the full truth and nothing but the truth about the US healthcare system along with solutions to read the book America’s Healthcare Solution. It was written by a very knowledgable man. See http://www.americashealthcaresolution.com for excerpts.