Dive Brief:
- A new proposal for reforming the American healthcare system by Manhattan Institute senior fellow Avik Roy, "Transcending Obamacare," has received some attention as being the most detailed conservative alternative to the ACA.
- The heart of Roy's proposal is a universal exchange plan that would gradually move everyone to individual insurance policies through the exchanges. The exchange design is complex, but among other things, it would allow insurers to charge older individual six times as much younger individuals; include a benchmark plan deductible of $7,000 per individual and $14,000 per family; and shift open enrollment to every two years.
- Critics say Roy's assumptions are questionable, arguing that studies that Roy uses as evidence for his proposal don't show what Roy claims they do or suffer from problematic metholodology; for example, a study that found people are better off being uninsured than on Medicaid.
Dive Insight:
Regardless of whether you agree with Avik Roy's politics, it's hard to argue the bottom line of critic Timothy Jost's analysis, which is that Roy's proposal does nothing to address one of the core problems of the ACA: its unwieldy complexity. According to Jost, "we are doomed continue to struggle with this complexity as long as we stubbornly cling to a private health insurance-based healthcare financing system." Regardless of how you finance care for the uninsured, it's highly unlikely that a multi-tiered system run by governments, health insurers, employers and consumers can be streamlined and tamed into a system which efficiently deals with the problem of the "have-nots" of healthcare. However, given that it is the system we have and that it's unlikely we'll see a dramatic change (such as a shift to single-payer) in the near future, there's no choice but to grapple with the fractured, unwieldy mess that we have.