For seven years they told us that if they just got control of the House they would repeal and replace the Affordable Care Act. (aka Obamacare). They did in the elections of November 2010 and produced nothing.
So the mantra began, “If we just get control of the Senate we will repeal and replace Obamacare.” In November of 2014 they did and still nothing.
“Now,” said they, “if we just held the Presidency we could repeal and replace Obamacare.” Mr. Trump promised that if he was elected President he would do so “on the very first day.”
It appears that the Republican Party was absent on the first day of school.
It was like they didn’t really expect to win the White House in this election (Who thought they would?) and figured they could put off doing their homework for another four years. To put it directly they were not ready.
Is it any wonder that real conservatives were deserting the party in droves. Here is how Shepard Smith of FOX News (Yes, FOX News!) summed up the situation moments after the President and Speaker Ryan had to pull the bill.
Republicans voted to repeal Obamacare more than 50 times when they didn’t have a president in the White House who would ever sign it. And now that they have a president in the White House who will sign it, they can’t get the one thing they’ve been screaming about for seven years done.
This is an obvious indication that it’s much easier to be the ‘no’ vote than it is to govern. 1
For seven years they could have learned and taken notes from the national social experiment that was going on before them. The Affordable Care Act was too cumbersome to administer but people grew to like it because it gave them the things they wanted.
We like the idea that there would be insurance available to everybody when they needed it. We like that we couldn’t be denied coverage because of a pre-existing condition. Parents and their “children” who could grow to the age of twenty-six liked the idea that the kids could have insurance through their parents policies. They didn’t like the idea that they were living in their basements but that is another matter. We just didn’t want to pay for any of it in mandates or higher insurance costs.
And we certainly didn’t want to subject ourselves to a tax that would have been the most lucrative of all. According to George F. Will:
About 180 million Americans are covered by employer-provided insurance, which is not taxed as what it obviously is - compensation. Republicans have abandoned a measure to treat as taxable income a small portion of the most generous employer-provided insurance plans, and have postponed for a nearly decade - meaning, probably, forever —- the “Cadillac Tax” on such plans.2
No matter what plan is brought forth it will cost money. The “Area 51" members of the so-called “Freedom Caucus” will just have to understand this. So, here is my humble proposal.3
First, everybody is enrolled in medicaid - from the President to the pauper at the bottom of the expressway ramp - affording all people the most basic health care coverage.
There would be no false promises here. If your doctor was willing to work for the medicaid reimbursement rate, great! If not you would have to find one that would. Sorry.
Second, employees would be encouraged to either band together with other like-minded individuals to purchase insurance as a group. Or, they could join a labor union (Whose membership has been on the decline.) that could negotiate with employers for better coverage than medicaid offered to be purchased from insurance companies.
For example, I have an option of Silver, Gold or Platinum plans for my insurance coverage with increasing costs as the coverage becomes more comprehensive. The theory behind this is obvious. The better the plan the more likely the most talented people will want to work for your company.
However, to Will’s point, any plan offered above basic medicaid would be taxed as compensation. This should make the brave souls in congress, who have the best health care plans of all, go running for cover like banshees on fire.
And, while this would be cutting off my own nose, premiums would increase along with age. This idea was proposed by none other than that radical leftist Dr. Charles Krauthammer.
Sixty-year-olds use six times as much health care as 20-year-olds, yet Obamacare decreed, entirely arbitrarily, that the former could be charged insurance premiums no more than three times those of the latter. The GOP bill changes the ratio from 3-1 to 5–1.
Premiums better reflecting risk constitute a major restoration of rationality. (It’s how life insurance works.) Under Obamacare, the young were unwilling to be swindled and refused to sign up. Without their support, the whole system is thus headed into a death spiral of looming insolvency.4
This insolvency was caused by not having enough healthy people signing up and paying in than older, people. Why would they? There was no upside for them.
The problem was the penalties. Another crazy idea. They weren’t enough!
The reason parking tickets work is that the penalty is markedly higher than not feeding the meter. Nobody wants to risk a $100+ ticket when they could pay $ 8.00 to park.
In many cases in the ACA it was cheaper to pay the penalty than it was to purchase insurance. Who would do that? Especially when if one did get really sick you were guaranteed coverage. Some likened this to buying fire insurance while the house caught on fire.
While I am not accomplished in the art of the deal I do have a modest proposal to offer as starting place that would benefit almost everyone.
All would get basic insurance through Medicaid even though they may not get immediate access to state-of-the-art medicine.
Those who wished to pay more or who, through collective bargaining or their own pockets, wanted concierge medicine would have it available although there would be a tax on the recipient. The free market would reign.
Even unions and insurance companies would be the beneficiaries. Who better to represent groups of people in an insurance market than a union? Who would sell those premium policies? Insurance companies!
Everybody has realize that there will never be a perfect plan. Just like there has never been a free lunch.
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1. Elizabeth Preza, “Shep Smith nails Trumpcare fail: GOP’s been ‘screaming’ about this for 7 years and can’t get it done." RAWSTORY.com
https://www.rawstory.com/2017/03/shep-smith-nails-trumpcare-fail-gops-been-screaming-about-this-for-7-years-and-cant-get-it-done/ (accessed March 25, 2017)
2. George F. Will, “Whatever replaces Obamacare will look a lot like Obamacare.” The Washington Post. March 22, 2017. https://www.washingtonpost.com/opinions/whatever-replaces-obamacare-will-look-a-lot-like-obamacare/2017/03/22/d7ae5d6e-0e5c-11e7-9b0d-d27c98455440_story.html?tid=ss_fb&utm_term=.b0445ef256a4 (accessed March 26, 2017)
3. This was first proposed in a conversation with Mr. Ted Davis, a member of my Bible Study group. Unfortunately, I can remember where Mr. Davis’ thoughts ended and mine began.
4. Charles Krauthammer, “The Real World of Obamacare Repeal.” The National Review. March 16, 2017. http://www.nationalreview.com/node/445841/print (accessed March 26, 2017)
