What is going on with Obamacare, otherwise known as the Affordable Care Act?  Spirits were high about quick action in the House and even the Senate.  Ideas have not been lacking—there are several plans out there to replace the present law.  The obstacle seems to be the usual collective suspect—politicians and their obsessive worry about re-election.  It is simply a fact of life that politicians generally want (desperately?) to be re-elected once in office.  That is not likely to change, given human nature.  When we consider that fact in the context of Obamacare, one can see that different politicians have different concerns about what to eliminate and what to keep.  Should we keep the taxes?  Eliminate the taxes?  Keep pre-existing condition coverage?  Eliminate it?  Allow competition across borders?  Restrict it?  Require insurance coverage for all?  Make it optional?  And how do we pay for those who cannot afford coverage (by the way, a much smaller number than the total of people who don’t purchase coverage)?  On and on the list of concerns goes for politicians.

The result is that we begin to see resistance by enough Senators and House members that the move to “repeal and replace” has slowed down.  Perhaps that is a blessing in disguise.  I would like to see a little more deliberation.  Moreover, the law is so intertwined with so many other statutes that it will take time to sort that out.  But that said, it also seems that perhaps this slowdown is more fear than any careful consideration of the policy issues.  I can’t judge all motives—except perhaps those of the politicians at the Congressional retreat whose voices were caught on tape.  I am going to go out on a limb and make a few suggestions for action.

First, and this was an excellent insight by Philip Klein in the Washington Examiner, January 26, 2017, freeze all new enrollment in Obamacare AND allowing those who receive benefits to continue.  This action avoids the problem of simply cutting off everyone and then having no way for those who need insurance to get it and it also prevents an interminable continuation of the program.  Under this proposal, there would be a definite cutoff date for new enrollees and no new enrollees after that.This would also allow Congress to address the problem of those who can’t afford insurance by separating the problem of poverty from the problem of healthcare.  Subsidize the poor for healthcare but don’t make everyone else enter into a broken system that exacerbates the healthcare problem.

Second, we must introduce competition into healthcare.  It has been long absent.  This includes competition among insurers, among medical providers, among hospitals, and among those making medical technology.  The market ought to be wide open with no state boundary restrictions.  In addition, I would propose better ways to train more doctors by allowing more medical schools to open in all states.  State governments in collusion with state medical associations have been the major culprits in preventing this greater supply to emerge.  More nursing training and other medical professional training ought also to be allowed, private and public, though mostly private and without restrictions except basic competency, to be tested and measured objectively and without political interference.  Insurance providers must be allowed to compete across state lines for any and all health insurance products.

Third, as of now most people get their insurance though employers and when they leave that employment, they can’t “take it with them.”  Congress ought to unbundle health insurance from employer provision, so that an employee can take their insurance coverage with them as they wish, or get a new provider.  It would be up to the consumer.  Competition once again would be introduced, driving down costs and allowing innovation.

Fourth, what will we do about coverage for pre-existing conditions?  Here is a political time bomb if ever there was one.  Obviously pre-existing condition coverage is not really insurance at all but simply a subsidy.  But many people don’t care and want it to be available.  I don’t have an easy answer for that except perhaps to allow so many innovations in insurance coverage that one might be able to purchase almost any kind of or unlimited coverage for a price.  The price might be higher, but one could still get insurance.  To continue pre-existing coverage as insurance when it is not invites an incentive whereby people flee actual insurance and just wait to get sick.  This bankrupts any system over time.

Fifth, get rid of the taxes.  All of them, but especially the “Mandate.”  There should be no need of these kinds of taxes since we are no longer taxing some to subsidize others with respect to healthcare.  Any subsidies are from general revenue taxation, not special taxes.

These and other actions introduce competition, eliminate a bureaucratic (and rather dictatorial) nightmare, incentivize better quality, and provide greater choice, all at relatively low “political cost.”  Will Congress pass some or any of these proposals?  I have no idea, since I am not a prophet.  But perhaps someone out there is accidentally reading this.