GOP must come together to repeal and replace Obamacare

Recalcitrant Republicans both in the middle and on the right must come together to repeal and replace Obamacare. Do not let the perfect be the enemy of the good.

In particular, Republicans need to capture the narrative. The "loss" of insurance by 23 million Americans has captivated media attention. That is wrong. Nobody will "lose" anything they have today.

What may happen, according to forecasts that we know are unreliable, is that some 15 million people who were forced by the federal government to buy a product they did not want will no longer buy it, and some able-bodied working adults will not in the future be eligible for Medicaid.

A better narrative would be about freedom to choose rather than government coercion, and about making sure that Medicaid remains solvent by keeping it true to its original intent--vulnerable women and children, not able-bodied men.

Why do Republicans continually allow themselves to be boxed in by Democrat Party narratives that make them look evil?

With some changes, the American Health Care Act could be a good placeholder, but doesn’t constitute true reformation of our dysfunctional, unsustainable healthcare system.

Don’t think that once Obamacare is repealed and the placeholder is operating that Republicans will be let off the hook on this issue. The GOP still needs to re-imagine the entirety of American healthcare so that it works for all Americans and is sustainable.

Now is the time to be thinking about a solution to healthcare in America that replaces Medicare, Medicaid, the healthcare elements of Social Security. And that can’t be done at the state level.

It's time for our elected officials to go back to work. Having touched this third-rail of American politics, the GOP could suffer for it just as Democrats have unless they solve it once and for all.

After years of fervent promises to repeal and replace "Obamacare," President Donald Trump and GOP congressional leaders buckled at a moment of truth Thursday, putting off a planned showdown vote in a stinging setback for the administration.

The Republicans need to settle down a bit concerning the repeal and replacement of Obamacare.  The pressure is increasing to change Trumpcare / Ryancare to capture uneasy Republican votes.

Soon, the GOP may have a passable bill because it damages fewer people; and that will allow for the repeal of the Obamacare. President Trump will sign anything credible to move on to taxes, regulation, immigration and defense.

For the last three or four years I've been proposing a simple plan:

1. Health savings accounts that would be topped-off directly by government for the very poor and neediest.

2. Beyond the HSAs that people would use to pay for all routine medical services, true catastrophic portable health insurance.

3. Enact tort reform to reduce defensive medicine, over-testing, turfing problem patients, and general reluctance to take on more patients.

4. Do away with government designed insurance and state insurance barriers. Deregulate insurance markets and take away the power of state insurance commissions which treat insurance companies like private fiefdoms

5. Do away with most government regulation but require transparency of pricing.

6. Repeal the EMR requirement which is a crippling burden for small medical practices. Obama thought destroying sole practices and forcing smaller clinics to merge with larger hospital groups was a good thing, another step toward centralized socialized medicine. However it did not improve quality of medical care, actually hurt quality of medical care, and raised costs.

7. Repeal the various ACA taxes: the 3.8% arbitrary tax, the medical instruments excise tax that is killing America's medical instruments industry, and the personal tax.

8. Repeal the most expensive and extreme requirements such as gender reassignment, fertility, pediatric dentistry etc.

9. Allow high deductible, low-premium plans again, so that individual working people will be able to once again pay for their own plans and choose their own doctors.

10. Get rid of the exchanges. Fund free/low-fee clinics in the big cities, to fill the gap for those caught between jobs and no funds to pay for health insurance. A few billion into these clinics would be a great investment, compared to a trillion dollars wasted on the Obamacare boondoggle.

These are just a few ideas I've had, and others have proposed, over the past few years to get our health care system into the modern era. A vast, centralized, socialized system is not the way to go.

The strength of our economy and of the American people is our creativity and decentralized, individualistic approach. We should use that to our best advantage.

When completed with the next two phases the House proposal would take us precisely there.

The GOP's failure was allowing progressives to create a new entitlement. Once they did that, Republicans can’t just replace it after having conferred it: they must come up with something that works better but is sustainable.

Do the progressives and liberal media even know what they are talking about? It was the hubris of Democrats thinking they could implement a reform as huge as Obamacare that in practice ended up destroying what was in part a good idea. They had their chance and blew it but now they want to stop Republicans. I guess they are afraid that they may succeed and actually help the people. That would be horrible because it may block Democrats from power for many years.

The irony of Obamacare is that the healthcare half of the law would have actually been a major step towards increasing the use of market forces, but the regulatory half, put in place because of the distrust of market forces, is what killed the whole thing. On one hand Democrats want market forces but on the other they don't trust them and believe they can do it better, and that only leads them to shoot themselves on the foot.

The key to understanding the market side of Obamacare is the 40% Cadillac Tax. When fully implemented all companies would have been affected. When that happened health benefits would no longer be tax deductible to companies so they would have given us that benefit as extra pay. Never mind that that represented a hidden tax we would have had to pay from our pockets thus raising more revenue for the government. Obama kept postponing it because of incompetence in the implementation of the first steps.

Anyway, when fully implemented we would be buying our own insurance and that’s why the exchanges were needed in the first place. The high deductibles would have been the key. We would have to be more careful with how we used health services, and we would shop around for lower prices, thus driving down prices and costs. Under that new system healthcare insurance would in effect become catastrophic insurance. Market forces would reign supreme.

The huge regulatory apparatus would keep providers honest. In this respect how Obama campaigned back in 2008 and 2009 for his new healthcare plan is very instructive. Remember how he used to give as an example that under the new plan doctors would no longer take out our tonsils unnecessarily? I always wondered whether that meant there will be a bureaucrat looking over every doctor’s shoulders to make sure they didn’t do unnecessary procedures.

In a less cynical way, what the new plan hoped for is that because the doctor knew most of the cost of the tonsillectomy would come out of the patient’s own pocket, he would be careful not to get you stuck with unnecessary expenses—doctors also free ride from the insurance and government tills.

That, in a nutshell, is what the real Obamacare was about. The market half would not have been that bad if Democrats didn’t fear people abusing other people so much—except of course Democrats, who never abuse anybody—and as a result shooting themselves on the foot by trying to do so much and everything themselves, thus creating a mess in the implementation.

It was the hubris of the Democrats believing they can do it better than the market even while paying lip service to it that made their plan fail. Let’s not make the same mistake on the Republican side. Just let the market do its job with very selective simple direct transparent subsidies for the truly needy but that's all.

Republicans have to get off the dime and bring back market forces. Anyone with an open mind and clear head knows that while some of its elements are good, as a whole ObamaCare is failing miserably and will hurt many more than it already has come next year.

Fix it, say liberals, preferably with a single payer system. A system like Medicare, they say. Well, ask any recipient of Medicare and while happy with most of it, if they have many problems they'll tell you how it too is failing.

Take primary care. Because of their reimbursement levels there has developed a serious shortage of primary care physicians, most obvious by how many Medicaid patients still go to the ER--by some data more than before ObamaCare. When ObamaCare was passed one of its objectives was to fix primary care but true to politicians and bureaucrats fixing those things, as evidenced by the higher demand for ER services, it has actually gotten worse.

Well, then go all the way like in Canada or the U.K. or the VA, liberals will tell you. Any objective observer knows that all of those systems have very long waiting lines for some services. Sure, there are many happy campers but there are also many who aren't. Just watch on C-Span the weekly Questions to The Prime Minister and listen to the continuous criticism. Half of the questions PM Theresa May gets are really complaints about long lines waiting for services from the National Health Service.

And there is very good reason for all of the problems with government run systems. In a market economy prices signal developing shortages that incentivize suppliers to build more capacity. In a government run system the only way to know shortages are developing is by the length of the waiting lines. But then instead of responding with more capacity people are blamed and some even hide the problem to avoid being penalized for not solving it.

So, Republicans, get off the dime and bring back real market forces with minimal regulation and government meddling. What you have provides a good starting private sector foundation that can be fixed down the road.

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