The latest attempt to repeal and replace “Obamacare” has failed, despite a Republican controlled Congress and a president that ran as a Republican, but is demonstrably a party of one. The Ryan plan, dubbed the American Health Care Plan, remained too socialist and liberal for the conservatives, too generous to the wealthy for the Democrats, and too weak to be a meaningful replacement for the more robust ACA. I’m glad it failed. It was an extreme and poorly crafted alternative. This is the best they could come up with in seven friggin’ years??!! And then they were willing to bend over for the “Freedom” Caucus and demolish women’s health care. Spineless tools.

Not that I am all that happy with the ACA. Most folks agree that certain aspects of Obamacare are winners,the pre-existing condition requirement, the age 26 coverage as a dependent, and the expansion of Medicaid, seem to be the top three. Major mis-steps are the pricing structure that allows healthy individuals to forego coverage unless they pay a penalty, and the mandated coverage of certain items that are not universally needed. Either way, a person starting out in the workforce has a new expense that will delay many desirable milestones as a contributing citizen. It makes it more difficult to buy that first home, start a family or own a business, and erodes any attempt to plan for the future. Insurers were left offering policies with unneeded coverage line items that inflated premiums and made plans unattractive to potential buyers. That whole pricing/minimum coverage strategy coupled with tax implications are the biggest flaws of the ACA.

My question is: Why must we repeal and replace the entire Act? That’s extreme! Shouldn’t we be gathering our experts and stakeholders to work with Congress and find a workable solution? Congress should be representing the best interests of its constituencies, not special interests such as Big Pharma, behemoth insurance companies and their CEOs, or other members of the oligarchy.

Medicare has worked relatively well for decades. This despite the government “borrowing” all of the money that we have paid into the trust fund itself. The funding strategy is not as convoluted as the ACA and with proper changes in design, intelligent limits on coverage, and aggressive fraud deterrence, a national health care plan is possible. We should cover every American with a basic level of coverage starting with first breath. A balanced fee structure could be designed using a person’s age and income (ability to pay) to determine a reasonable premium. Note that I said basic coverage, you can read that as catastrophic coverage if you like. The main point is to provide federal coverage for all. Once we agree on that we can start to discuss incentives for healthy behavior and limits to care for self-inflicted conditions. We can balance payments according to age and ability to pay. We could even consider levels of coverage above the basic as people entered the workforce while creating incentives for people to seek gainful employment. States could take action to help those at greater risk and lower abilities. I’d still like to see everyone contribute to match their abilities.

This would not mean the end of more robust plans, which could be offered by employers as part of an attractive benefit package. HSAs could easily survive.Once the baseline coverage foundation is established, building on it in the marketplace, either through private purchase or as part of a group (be it employer or other groups), can fulfill that burning Republican desire for capitalism in health care. Although we need to be very careful how this is crafted.

I wonder if we see this extreme behavior to completely destroy Obamacare as a reactionary dislike for our first Black president simply because he is Black. I’ve told my Senators and Representatives that I want the ACA made better, not destroyed. That is how we made America great, by building on our successes and revising and improving on ideas that didn’t meet expectations. Not by the extreme politics that we are seeing now.

And while we are at it: One of the components of the ACA was to limit health insurance executives to $500,000 in tax deductions. HHS Secretary, Tom Price stated that it is unAmerican to single out these individuals.
I agree! Why not have that $500,000 limit on everyone? We could exclude charitable donations to true charities (NOT PACs!). No one is singled out. Problem solved!
Who the Hell needs more than half a million in tax deductions??? Yeah, I can think of one guy too.

Finally, no matter what we do, the end result should be something that can be easily understood by the average Joe. No more of the coverage gap, you pay this % we pay that %, Big Pharma gives you a discount (wink, wink), spend this much, we match, check out of pocket, cover this today, not tomorrow, authoritarian health rules. I must be able to explain coverage to my patients! Preferably in two sentences! That would be Great!