Dept. of Alternative Facts: Repeal and Replace

repeal (v) to formally revoke

replace (v) to provide a substitute

For several years, the Republications in congress presented bills to repeal the Affordable Care Act.  Without sufficient votes to pass such measures, the score card of defeated votes began  to look like a very poorly played attempt to get into March Madness: 60+ to 0.  Now with assured belief that they have the House and Senate votes to pass legislation, and a Whitehouse backing, the Republications have woke-up to an awareness that they cannot just File-13 the ACA.  They must provide a substitute.  Thus, their proposal, the American Health Care Act is working its way through House of Representative committees.  As the acronym, AHCA, is hardly different from what it proposes to replace, ACA, I suspect that we are being offered GOP retread tires.

Congressman Mooney,

You mentioned that you support the repeal and replacement legislation for the Affordable Care Act. I do not support this effort, as I do not see the replacement option as providing much in the way of change.

A primary issue about the ACA is who makes the decisions about someone’s health care insurance. The critics of the ACA mostly do not like decisions being made at the federal level of government. “One size does not fit all”. Furthermore, they object that the national standards for what should be included in a health care insurance contract increase the cost of that care and potentially require paying for services that the individual is not likely to use or may disagree with.

The replacement plan essentially shifts the decision-making from the federal level to the state level. The argument is that states leaders can tailor health care to the region and constituents’ interests. I do not see much difference between relying on the good will or tyranny at the federal or state level. I am still abdicating my responsibility for my health to a politician or bureaucrat. For that matter, letting my employer select my health insurance options is not much different.

Health insurers have little incentive to develop innovative plans when they are told whom to insure and what to offer. If we get government leaders and employers to not stand between consumers and insurance companies, the companies would have incentive to create plans which people are willing to purchase at prices they are willing to pay.

Certainly, government could play a useful role in researching health practices (e.g. funding research with grants, establishing standards for care) and assuring that those who are vulnerable to not being able to afford health care have access (e.g. elderly, disabled, and unemployed people).

One limitation with creating health care plans which meet the needs of consumers is that the primary variables are deductibles ($200 or $2,000 or $6,000) and whether insurance covers only major medical expenses (e.g. broken bones, heart attacks, birth injuries, etc.) which cost tens-of-thousand’s of dollars verses preventative health (e.g. annual physicals, mammograms, reproductive health, smoking cessation, weight control, etc.) which potentially reduce tens-of-thousands of dollars in future expenses.

Having just filed my taxes electronically, I suspect that if computer programmers can create a series of menus to guide me through the tax code including re-calculating my refund or payment with each entry, they could create a health care cafeteria program that would let me decide what kind of health care insurance contract I wanted and fit my budget.

For my lifestyle, health status and age, I would select a comprehensive plan with a neurological, cardio-vascular, and cancer prevention options. Other than a motor vehicle collision while traveling to or from work, these are my highest health risks. Given that I am male and middle-aged, I do not need a reproductive health option, and diabetes and obesity are not likely to be my demise.

On the other hand, a young woman might want a reproductive option, and a young man better be covered for broken bones and traumatic brain injuries, given the risks young men are vulnerable toward. If that young woman did not believe that abortions were a method of birth control that she would use, she should have the option to opt out from such coverage. If someone’s religious beliefs proscribed other procedures (e.g. transfusions), he or she should have the option to opt of from these. For that matter, someone could complete his or her Living Will, Do Not Resuscitate, or Do Not Intubate orders right there and get a discount. Having such information completed and documented on one’s health card could save the rescue squad, emergency department, and insurance company undue expenses, when one’s stated health interests are followed from the get-go.

If I have a car that I dislike, changing the tires is not much of an improvement. If I want a different value car, I check out the auto dealerships. I can decide whether I want a Tesla or a Chevy. If you want to be bold about health care, develop the conditions which give consumers and choice and insurance companies incentive to develop a variety of options. We do not need GOP tires on the ACA.

Yesterday (3/21/1)  President Trump circled the wagons of the House GOP trying to rally the troops to vote “yes” on AHCA tomorrow (3/23/17).  Those who question whether this is the bill to pass did not seem convinced.  Joking or serious, President Trump reverted to
his bully-in-middle-school attitude and threatened that those who vote “no” would not be re-elected in the 2018 election cycle.  Some he humiliated by name.  Others, he implied that Trump backers would go after to defeat.

Rashly drafted and poorly presented legislation need not be approved merely because his friends did not write his term paper correctly.  D- work should not get a B+ grade because the bully has a tantrum.  Send the AHCA back for re-writing.