Why Is Health Care So Difficult to Solve?

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Answer from Michael Lee, Public Policy Analyst:

Health care policy involves a lot of political challenges. Leaving aside the policy questions for the moment—let’s just talk politics—the challenges include:

  • Path dependence or inertia. Once something gets going in government, it’s really hard to stop it, because it develops a constituency that agitates to protect it. This is true more broadly than health care policy, but it’s particularly acute in health care, because of…
  • Risk aversion. People don’t like things to change too quickly or too drastically, particularly when it comes to individual benefits. And health care policy involves a lot of people receiving benefits in some form or another! And fundamentally, those benefits involve…
  • Costs. Health insurance as currently structured in the U.S. is expensive. It doesn’t necessarily have to be that way, but see above: radically reshaping health insurance offerings to reduce costs is challenging, and a lot of people rely on subsidies, either via the government or their employers, to purchase health insurance or obtain health care benefits. Any effort to expand health care coverage further gets expensive, and Americans have a well-known aversion to paying more in taxes.

With a stunning late-night vote, Republican Senators John McCain, Lisa Murkowski, and Susan Collins crossed party lines voting against the GOP’s “skinny repeal” version of Obamacare reform. Zach Gibson/Getty

So when talking about the Republican health care proposal this year, even leaving aside the policy issues, we have a new government entitlement in the form of ACA’s insurance subsidies that now has a constituency (both via the insurance industry and the covered individuals) that doesn’t want things to change! But reversing field (even if Republicans were interested in building on ACA) isn’t too workable either, because it would require new tax revenue to cover more people.

Remember, Democrats in 2010 passed ACA even though it had a lot of problems and didn’t really reflect their policy priorities. And they did it because it moved the ball in their direction and they were convinced that they’d be rewarded by the voters for providing a new benefit. That hasn’t happened quite yet, but voters still agitated against the Republican proposal because it would have reduced health insurance coverage compared to current law.

It remains to be seen where we go from here.

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