The Affordable Care Act is broken, but it can be fixed if Washington seriously tries. That's unlikely to happen until after this mephitic election, in which health care has become yet another toxic issue dividing candidates.
Democratic presidential nominee Hillary Clinton wants to repair Obamacare, in part by increasing subsidies. Republican nominee Donald Trump wants to kill it, but doesn't have much of a plan to give 20 million formerly uninsured people health care.
Politicians should realize that even the most reckless members of Congress can't deprive 20 million people of their health insurance. Imagine the uproar when constituents find out who voted to dump the coverage for them and their loved ones? Constituents will know. Their health care providers will tell them who's responsible when doctors deny children care or adults a visit to find out what ails them.
A big crack in Obamacare will show up Nov. 1, when an average 25 percent premium hike will face about 2 million people with incomes too high to qualify for subsidies who don't have Medicare or Medicaid. Consumer costs will go up from 5 percent in California to 145 percent in Arizona, according to a Kaiser Family Foundation analysis of low-cost plans. Locally, plan costs are estimated to rise by 7 percent in New Jersey and 51 percent in Pennsylvania.
The wild differentials are largely due to poor management, sloppy drafting of the legislation, loopholes, bad cost projections and greedy behavior by the health care and major insurance companies, particularly Aetna, which threatened to drop out of the program if the government opposes its mega-merger with Humana.
But this isn't hopeless, if policy makers recognize what the public wants. That includes coverage for pre-existing illnesses, charging women and men the same rates, and covering adult children up to age 26.
There are good ideas to save money. California's increase is low because it aggressively negotiates with carriers to keep costs down. Clinton's suggestion of offering Medicare to people aged 55 to 64 increases competition in a shrinking market. Loopholes that penalize families if employer plans are too pricey should be closed. Carriers should not be permitted to undercut exchanges by offering low-cost plans to healthy single people because it takes too many out of the risk pool. The revised plan should also stop letting people buy insurance when they're sick and drop it when they're better. That just costs everyone else more money.
Medical costs were hardly touched in the original bill thanks to more than $1 billion in industry lobbying. This time, policy makers must stop drug companies and physicians from charging excessive prices, like Mylan's 600 percent increase for the EpiPen or a family doctor's $160 charge for a flu visit.
The Republican tantrums on display in the 50 votes to repeal Obamacare has to make way for reasonable conversations that solve, rather than ignore, the problem. Most Democrats acknowledge that the program is flawed which means both sides need to either fix it or get used to constituents bringing sick friends and relatives into their district offices to ask what's wrong with their representatives.