Repeal Obamacare and Fix Health Care This WayOctober 27, 2013
Mere weeks into the full rollout of Obamacare, the stench of its rot overwhelms. Americans, many of whom supported the Affordable Care Act, hold their noses as they read cancellation notices from their insurance companies and scramble to get new coverage. They grimace as HealthCare.gov crashes, and they lament the good old days before Obamacare when their policies better fit their needs and cost less to boot. Obamacare is not what most Americans signed up for. Obamacare is bad for America. So now what?
Repeal Obamacare. Ditch the Affordable Care Act. Return to the system, the access, the level of regulation in place BEFORE Obamacare became law. Those days weren't perfect, but to improve access to health care and control costs, the very first thing to do is to rid ourselves of the new health care law that is only adding cost and complexity to the system.
After repeal the next step is to redefine the goals of insurance -- traditionally a backup plan that swoops in and covers the costs of catastrophe if the worst happens. With insurance, most people never make claims but do pay premiums -- allowing the insurer enough revenue at any one time to pay the claims it DOES receive and make a profit. We no longer look to health insurance this way, instead seeking out "body maintenance plans" that cover not just catastrophe but also routine and expected costs like physicals, vaccinations, basic prescription drugs, routine lab work, inexpensive testing, and elective birth control and surgeries. Under Obamacare these types of services, as well as others like childbirth, drug treatment, and mental health access, are all required in every insurance policy sold, greatly boosting the cost. Why should a man pay for child birthing services he will never use? Why should anyone pay for drug rehab or mental health treatments for which s/he has no need? These are silly and artificial cost increases that, when combined with the other routine health services we all use, add bloat and expense to the insurance system. Let's cut these out and reserve insurance policies for their true purpose: covering the unexpected medical problems that will hit some but not all of us.
Let's acknowledge our responsibility for our own bodies. We work jobs and earn money not just for toys but for necessities and self-care, and so we save our own money for the annoyances in life. We also earn money to buy insurance, and so let's next repeal EMTALA - the Emergency Medical Treatment and Labor Act of 1986 - imposing a federal mandate on hospitals to care for anyone with a medical emergency, regardless of ability to pay. Is it a compassionate law? Perhaps it is -- for those who receive services at the expense of others. Has the law been abused? Assuredly. Hospitals fear not only violating the law itself but also accusations and the expensive lawsuits that follow, funneling large sums of revenue into legal departments that fend off dissatisfied patients and work to keep the hospital above board. Because of EMTALA hospitals bear the burden of disproving an emergency to such an extent that they often use little discretion and treat most everyone who walks in. This business model is, of course, not sustainable -- requiring hospitals to pass these added costs along to others to keep their doors open, perhaps to the federal government or the state, most always to those patients who CAN pay in the form of higher prices. Repeal of EMTALA resolves the market distortion by freeing up hospitals to treat patients who can pay the bill, with or without insurance -- a good thing with respect to the consistency and quality of care we want.
Low-income, low-asset patients can better rely on co-ops and non-profit hospitals that focus on lower costs and efficiencies. This type of system becomes far easier to expand by taking another affirmative step: tort reform and deregulation. Let's create a tort system that balances the obligations of the insurance companies, the patients' needs, and the need for caregivers to avoid the high costs of frivolous lawsuits and expansive malpractice insurance coverage. Allow insurance companies to sell policies to anyone, anywhere, without regard to home state or coverage requirements. These changes promote new access to care by encouraging doctors and nurses to seek new channels of delivery without fear of overregulation, and a deregulated insurance industry boosts the number of consumers with policies that work the way they want and which cover WHO they want.
Finally, free up states to create a program to subsidize a public option to cover the "uninsurables" -- those with pre-existing conditions who can't be served adequately by a private market offering. These folks voluntarily pay premiums for the coverage they need, but the program is paid for, in part, by taxpayer dollars.
No reforms will generate 100% access to quality care for everyone, because laws by themselves can't mandate supply, demand, and any particular cost curve. Obamacare has further distorted the market, driving price increases across the board and narrowing access to quality health care -- exactly the opposite of what the Affordable Care Act purported to fix. By repealing Obamacare, refocusing health insurance on catastrophe, ditching EMTALA, passing tort reform, and deregulating the health insurance industry, we can take the steps necessary to optimize our health care system.
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