We Interrupt This Broadcast…

We are in a series looking at the recently published Republican plan for the ‘repeal and replace’ of the Affordable Care Act. Click here to find other posts in the series.

Helmuth, the Elder, was right.

I knew that trying to get through a series of posts explaining the House Republican’s plan to ‘repeal and replace’ was a fool’s errand, not just because of the fools involved in either the planning or the explaining, but because this thing is so fluid. 

So, today we are NOT going to dig further into the framework for Medicaid reform as planned (stop cheering…we’ll get back to it, hopefully Friday), but need to go live to the scene for some breaking news.

Oh, Helmuth. 

Helmuth Von Moltke the Elder was a Prussian Field Marshall who, in the mid-19th century, said,  ‘No operation extends with any certainty beyond the first encounter with the main body of the enemy.’  That great insight was a little wordy, so Eisenhower shortened it to, ‘No plan survives contact with the enemy.’  President Trump has now shortened it again. ‘Crap, healthcare is hard.’  It is not clear how royalties flow back to Helmuth, but the man should get paid.

Mr. Trump had the nation’s governors over for dinner Sunday night so he had an excuse not to watch (or Tweet at) the Oscars.  Monday, they thanked PriceWaterhouse for the temporary distraction and then got down to work, much of it focused on healthcare.  The president said, ‘I have to tell you, it’s an unbelievably complex subject. Nobody knew that health care could be so complicated.’

Huh, excuse me, but those of us who do this for a living kind of knew that already. 

What do you think, should we sign him up for the blog? 

This NY Times article provides a pretty good summary of the issues, but suffice it to say the plans for a rapid rollback have run smack into the enemy.  Or enemies, that is.  There are many…

  • The legislative process itself laughs, nay mocks, any sentence containing the word ‘rapid.’
  • Specifically, arcane Congressional reality means Trump has to deal with healthcare before he can address tax reform, so this is creating a log jam for his entire agenda.
  • Republican governors in states that expanded Medicaid under the ACA, often at great political risk at the time, absolutely do NOT want to now have to roll that back. On the other hand, Republican governors who did no expand Medicaid, also at their own peril, think it is wrong for their citizens to pay federal taxes that fund a benefit going to other states.
  • For Democratic governors, it is simple…never, ever reduce any benefit. Ever.
  • It turns out this healthcare stuff is expensive and while we can debate how the Feds and the states split the bill, and whether we use subsidies or tax credits or Skittles, someone still has to pay.
  • And oh yeah, there are the actual people, the citizens, who are up in arms – on every side of this issue.

Mr. President, you have now encountered the enemy.  Real battle is a little more complex than a campaign rally.

Back to the plan on Friday…that is, unless something big happens.


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

Yes, I'd like to get Tim's blog.