WHAT WOULD WE EVER DO WITHOUT EXPERTS?

Obamacare could collapse under Trump’s new plan, policy experts say.  Fine.  It's neither patient protection nor affordable care.  After politicians have tried everything else, will they try something that works?  A month ago, the editorial board of New York's Post wanted to put Obamacare out of its misery.  Forget Obamacare subsidies — it’s time to mend or END the whole thing.  "Obamacare was a calamity from the start: It raised taxes, destroyed the old (imperfect, but functional) private insurance market and slapped all kinds of requirements on insurers, spiking costs." That can has been kicked to the end of the road.

What’s left is an extremely pricey, Rube Goldberg system that provides, as health-policy expert Michael F. Cannon puts it, “junk coverage.”

Without the Obamacare law, he notes, the nonpartisan Congressional Budget Office estimates that most people could obtain better coverage at lower premiums. (And Congress could look to cover those left out with some targeted assistance.)

Democrats would rather keep burning money than admit their huge mistake.

They insist the law left more Americans with health coverage, but that’s largely due to the Affordable Care Act’s (hugely expensive) expansion of Medicaid.

Today, Medicaid, once a safety net for the poorest of the poor, covers one in every five Americans.

The ACA’s “temporary” federal subsidies to states to expand it were originally also set to expire — but Dems have kept those going, too.

Maybe Congress could extend these subsidies one more year to keep Obamacare on life-support, but Republicans — and Democrats — absolutely need to find structural fixes (if not a complete repeal) to boost choices for the public and access to better coverage and health networks, and to lower costs.

That means addressing key ACA provisions — on essential benefits, subsidies, preexisting and expensive illnesses, the medical loss ratio, community rating, etc. — that drive costs through the roof and limit choice.

"Expanded Medicaid" means more patients looking for care from practitioners and pharmacists who have not yet opted out of Medicaid reimbursement rates, which is one more time bomb waiting to explode.

Let's see how Politico presents the opinion of their experts.  "Economists and policy experts suspect President Donald Trump and GOP lawmakers are presenting this alternative to extending the enhanced Affordable Care Act subsidies because they want to undermine or even replace Obamacare — something the party has repeatedly failed to do in the past."  It's unsustainable, whether Congress recognizes it or not, and it well might fail of its own accord.

With direct cash payments from the federal government into special accounts, “healthy people could get much cheaper insurance that has medical underwriting and doesn’t cover preexisting conditions, but that would leave much sicker people in the ACA pool, and likely send it into a death spiral,” said Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research organization.

If younger, healthier consumers choose such so-called junk health plans — with lower costs and less robust coverage — or don’t use the money for health insurance, it could throw off the balance of risk and prompt insurers to exit the market entirely, Levitt and others said.

Republican proposals for the direct payments still lack key details. They include creating health savings accounts or flexible spending accounts for millions of Americans and depositing cash into them instead of providing the enhanced premium subsidy that goes directly to health insurers.

That "KFF" refers to a spinoff from the old Kaiser Family Foundation, and judge from Mr Levitt's biography how nonpartisan they are.  "Larry Levitt is the executive vice president for health policy, overseeing KFF’s policy work on Medicare, Medicaid, the health care marketplace, the Affordable Care Act, racial equity, women’s health, and global health."

Keep reading Politico, dear reader, and note the absence of any discussion of price discovery or trade tested betterments or breaking the connection between employment and health insurance or perhaps allowing people younger than 35 or 45 to buy maintenance coverage for annual physicals, catastrophic coverage for just in case, and opportunities to contribute to health savings accounts that could accumulate for years.  That's too much originality for their pool of experts.

Providing health insurance subsidies, like the enhanced Obamacare tax credits, meanwhile, can have an upward impact on health care price inflation, because people are more likely to seek out medical care if they’re insured, they said.

But the Republican plans, depending on how they’re designed, could prompt fewer people to enroll in ACA marketplace coverage.

“People are not going to buy as much insurance as before, and these markets do seem to struggle to sustain participation and competition from insurers, and so if there were this type of large wholesale shift from subsidies to cash payments, I would expect enrollment to drop significantly, and I would expect insurers to pull out of the markets,” said Tim Layton, an associate professor of public policy and economics at the University of Virginia.

Americans, especially if they are young and healthy, might also opt for cheaper health plans that do not have to comply with the ACA, including short-term health plans, which aren’t required to cover essential services like preventive screenings or maternity care, experts said.

“You’re going to leave a bunch of people who have an unfortunate health event just in a catastrophic situation,” said Vivian Ho, chair of health economics at Rice University.

To what extent are people in a catastrophic situation without catastrophic coverage because that's no longer an option?

Moreover, until somebody is willing to talk about price discovery, the third-party payment effects will stay with us, which might be the primary driver of rising health coverage premiums.  (Note, I do not say "costs" as nobody knows what the opportunity cost of relevant services are.)

But giving cash directly to Americans to purchase health care as opposed to health insurers is also unlikely to largely “bend the cost curve” because consumers typically aren’t armed with price data to shop and compare the most cost-effective plans, said Robert Kaestner, a research professor at the University of Chicago’s Harris School of Public Policy.

That means the major cost drivers in health care — the prices and networks that providers and insurers negotiate — would likely continue to keep costs high for consumers, he said.

“The idea that consumers will be more cost-sensitive and make good choices is really overblown,” said Kaestner. “They still have to rely on insurance companies putting together networks, getting the price discounts that they get now.”

Now might be the time to start over.  Mark Tapscott referred to the same Washington Post editorial we noted some weeks ago to make that case.

Whether the Post editors realized it or not, with that paragraph, they endorsed the Right’s fundamental critique of the Welfare State since its advent in Bismarck’s Germany in the late 1800s. Somewhere, a stunned former President Ronald Reagan, who often declared federal programs to be “the closest thing to eternal life we will ever see on this Earth,” is declaring his amazement that “they finally get it.”

Even if Democrats succeed through the shutdown in salvaging some sort of interim preservation of the “temporary” Obamacare tax credit subsidies, think tankers on the Right point to a host of additional profoundly serious flaws in the government health care system.

“Rarely in public policy have we witnessed such a radical disparity between high-profile promises and real-world performance. Obama said that his signature bill would bend the health care cost curve downward. Instead, aggregate health care spending has soared,” Heritage Foundation Senior Fellow Robert Moffit told The Washington Stand.

The true purpose of Obamacare, Reason's J. D. Tuccille suggests, is to create a Galbraithian bezzle that old Ken might find reason to approve thereof.  Read beyond the excerpt to find some serious suggestions about how to end the bezzle.

This is sort of a fancy way of saying that Obamacare is part of a range of very expensive federal programs intended to insulate Americans from all the things they don't like about health care. None of the programs do anything that actually improves the quality of health care, nor do they help to lower its cost. Instead, at growing expense, they hide the burden and put off the day when reforms will have to be implemented. Calling Obamacare a scam isn't an exaggeration. It not only delays real reform; it's also easily gamed to line grifters' pockets.

There's rent seeking in government?  Is anyone surprised?  "Even the Liberal Media Is Admitting That Obamacare Is a Failure."

For years, Democrats sold Obamacare as a moral crusade that would make healthcare cheaper and fairer for everyone. Instead, premiums exploded, deductibles skyrocketed, and coverage got worse. When even CNN pundits are conceding that people can’t afford their insurance “even with subsidies,” the illusion of success is crumbling. No amount of spin can hide the reality that Obamacare’s signature achievement — affordability — never materialized.

From the beginning I have maintained that "patient protection and affordable care" are two lies in one short title, and if that reality is dawning on the political class, fine.