KEEP IT SIMPLE, SENATE

Well, here we go again. A little over a year ago, I wrote a blog critiquing the Affordable Care Act. In that blog, I made two very broad assumptions in favor of the ACA. Politics aside, the purpose of my assumptions was to allow an impartial analysis of whether the ACA was the proper solution to fix the problem it was designed to address.

Assumption #1: It is the moral obligation of a developed country like the United States to ensure that all people can obtain excellent healthcare regardless of their economic status, and even if they have a pre-existing medical condition.

Assumption #2: The ACA was the right priority at the time and deserved priority over an infrastructure bill creating jobs while remedying collapsing bridges and tunnels.

My observations of the ACA, from a decision-making point of view, seem to have been completely missed by every pundit on television. Here is why the ACA, and now the AHCA, are both the wrong solutions to the problem they were designed to solve…
They break a law! The law of decision making, that is.

As pointed out in my book, Never Be Wrong Again, one important law of decision making, is:

Simple problems require simple solutions; complicated problems require complicated solutions, and complex problems require complex solutions.

The ACA encompassed over 1,900 pages of law aimed at solving a relatively straightforward problem. The bottom line is that the legislation was far too complicated for the simple (yes, simple) problem it was designed to address.

Do not confuse simplicity with importance.

People need healthcare insurance, even if they can’t afford it. This is neither complicated nor complex. Medicine is complex, but buying health insurance is not. It is like the auto industry. The actual cars get more sophisticated and complicated each year. Buying car insurance is still easy, even if you don’t like the price.

The new (Trump) administration is trying to replace a complex law with another one that is also much too complex. They are violating the same rule of good decision making that the ACA did.

If everyone can use any doctor they want to prevent or cure an illness, then everyone is happy. The question is: Who pays? You don’t need 1,900 pages of over-complication to find the answer.

Here is why the payment solution is simple:

In an article in The New Yorker (May, 11, 2015), Atul Gawande noted that the Institute of Medicine (now the National Academy of Medicine) issued a report showing that waste in healthcare (mostly in Medicare) costs the system about $750B annually. Over a ten-year budget cycle, that is $7.5T (notice the “T”). That is more than enough to fix Medicaid and keep Medicare intact.

That’s enough money to fix the cost problem of guaranteeing insurance for all, with enough money left over to buy most people a new Model 3 Tesla!

A good approach to decision making doesn’t assume the solution will be simple and quick. But the problem needs to be assigned to one of 3 categories: