Repeal and Replace

Repeal & replace or repair. While there is importance to these words, they can be misleading. Sleight-of-hand is the tool of the magician ... and the politician and the subway thief. A band of entertainers enters your subway car and does magic tricks as their buddies relieve you of your wallet and other valuables. Those skilled at sleight-of-hand are never easy to anticipate and generate a lot of fun before they do their harm.

Repeal and replace gets the political base all fired up. Some people prefer to say repair but even that word elicits a political war cry. My eyes grow weary reading the endless minutiae. The Democrats will fight to the end over either repeal or replace. Republicans will argue the timing of the repeal and replace as if they were deciding which sit-com to watch first.

But stop sniffing a minute and realize that these words are there to inflame while the real issue is the improvement of the national healthcare system. D or R, we all believe that the system can be improved. Before Obama radically altered the system, most of us would have agreed that the system could be improved. And today, I think we know that healthcare isn’t perfect.

So why blab repeal and replace when what we all really want is improvement. Of course, we don’t agree on exactly what needs to be improved just as many of us held different opinions about Meathead in All in the Family. We are a nation of free thinkers. We love to disagree. Most bars would go out of business if we all agreed on everything.  

As we go about improving healthcare, it wouldn’t hurt to start out with some shared goals. We might not agree on the ways to reach those goals but let’s at least find some common ground. For example, most of us would agree that hospital gowns should have backs to them. No one likes a butt sticking out. And then there is the total avoidance of JD as a painkiller. That seems silly.

So now we have a place to start. Let’s move on. Another shared goal is access to healthcare. Let’s vote. Should we advocate limited access or wide access to healthcare? Everything else the same, let’s try to have a system that is available to most of us.

Second, let’s have a system that is affordable. Again it is easy to agree. Do we want a system that no one can afford, or do we want most people to be able to buy healthcare without selling the family's glug glug collection?

Third, to attain these goals we know there must be a mixture of market provision and government assistance. This is our tradition and is nothing new. We buy cars and cabbages in the free market yet we also have an extensive income supplement program for those with less capacity to purchase. We liberals and conservatives argue about the balance of market versus supplement but we pretty much agree that both are necessary.

Fourth, it doesn’t take Albert Einstein to understand that society must be able to afford this balance of market and supplement. Our hearts cannot rule our heads. Too much supplement doesn’t automatically make us Greeks but it could weaken our overall economic strength. 

Fifth, if the market is to provide healthcare then attention must be paid to the purveyors of healthcare – doctors, nurses, hospitals, insurance companies, pharmaceutical and medical device makers. There is no market without supply. Suppliers must want to provide their goods and services. At the same time, since parts of their earnings come from government supplements to the system, some supervision over their participation and prices is necessary.

Insurance will likely continue to be the basis of the healthcare system in the USA. Insurance markets exist in other venues – houses, automobiles, life and other financial products, and so on. Insurance has well-known principles. A major one is that many people pay into the system while others receive benefits. For example, good drivers pay for auto insurance each year and get nothing but piece of mind in return. But after some maniac who tries to change lanes with a margin of three feet going 90 miles per hour rams into you, then State Farm pays you to have your wrecked Lada replaced with a lovely Ford Edsel.

That’s the way insurance works. Some folks pay and some folks receive. If there are too few of the former and too many of the latter, then you have a problem. It makes absolutely no sense to let people enroll in insurance after they have a wreck. So any plan for health insurance in the USA will have to address ways to make people want to participate in the system when they are not ill. It seems to work for autos. I am not sure why we can’t find a way for healthcare.

It also seems related that people who find themselves out of a healthcare plan would be allowed to transition to another one. If someone has very serious conditions there should be an affordable way for them to find and keep insurance. Kids on parents' plans similarly need to be covered.

The above does not seem far out to me. Replace? Repeal? Keep your eye on the ball. We need a better healthcare system. Period. Healthcare reform always starts with something. Then you improve it. Now is no different from the past. Except for maybe the fact that people in both parties seem to have more fun screaming like banshees than actually doing something good for the country.