Latest posts by Jane M. Orient, M.D. (see all)
- SOTU 2019 and American Medicine - February 12, 2019
- So What If ACA Is Unconstitutional? - January 8, 2019
- Epidemics, Fear and Denial: How Every American Is Threatened - December 11, 2018
The time for Republican self congratulation is over, and the work needs to begin. It appears that the majority of the voting population recognizes that our country is in dire condition. Time is running out to fix it. Are Republicans going to work for our country, or just shift money around to different special interests?
It is not reassuring that some Republican Party strategists think they won because they purged controversial candidates who might make a campaign gaffe—and who might upset the ruling elite’s agenda if they got elected. Or that Democrats seem confident that Republicans will “work together” with them to continue the Progressive agenda—or else Obama will do it all by himself.
Republicans can no longer blame Harry Reid for their failure to repeal or defund ObamaCare. They can’t just take symbolic votes and complain (not too loudly) when bills get bottled up in the Senate. It’s on them now.
ObamaCare is deeply unpopular. Millions have already been hurt by it, and the real pain will begin now that the election is over. Millions of insurance cancellations, IRS penalties, and sticker shock for renewal premiums are about to hit.
And that’s just the financial pain. Loss of access to physicians and hospitals, and the diversion of physicians’ attention to rule compliance instead of patient needs are harder to measure. It’s also harder to blame the government instead of doctors.
Not all of these problems are from ObamaCare alone, but can be traced to previous laws such as the HITECH Act and other “incentives” for physicians to buy expensive, error-ridden computer systems and follow protocols—or else be punished.
Every mandate, and every dollar taken from taxpayers, is income to somebody: managed-care cartels, information technology vendors, government bureaucracies, etc. With every day that passes, ObamaCare thus becomes more deeply rooted, like kudzu, and harder to extirpate.
And then there’s the reckless disregard for the law that has characterized implementation: selective waivers, politically motivated delays, and blatantly rewriting the law to provide taxpayer subsidies explicitly forbidden in Exchanges not created by States.
Congress needs to start now, and not allow the lame-duck session to wreak havoc. Reid needs to be faced with well-publicized bills to mitigate damages, pending repeal. Measures should include:
- Grandfather all existing health insurance policies indefinitely.
- Suspend all federal coverage mandates for new and renewing policies.
- Provide that insurers may price policies fairly, based on actuarial risk.
- Eliminate restrictions on health savings accounts and self-insured plans, especially re-insurance
- Make the individual mandate/tax “shared responsibility” payment truly voluntary, like the contribution for elections.
- Delay the employer mandate indefinitely.
- Suspend the medical device tax and other ObamaCare taxes until and unless they are specifically re-enacted.
- Clarify that the law really means what it says about subsidies being available only through State Exchanges
- Abolish the Independent Advisory Board (IPAB) and deny any agency the power to constrain prices or spending in the private marketplace.
What these provisions have in common is six features that Republicans should demand of all legislation:
- They return control of medical spending and decisions to individual Americans, instead of forcing them to subsidize insurance companies and social engineering schemes. They stop the extortion of money from all Americans to funnel through devious pathways to people behind the curtain who do nothing to provide care
- They remove barriers to private enterprises instead of erecting new ones
- They impose no selective stealth taxes. If Congress is to tax people, it must do so through transparent, constitutional means.
- They do not expand the reach of government into areas in which it has no constitutional authority.
- They create no new agencies through which Congress can further abdicate its authority to the Executive
- They reduce the governmental footprint on the necks of Americans.
It’s a long way to constitutionally limited government, fiscal solvency, and an atmosphere of freedom in which all Americans can thrive and prosper. But we need to take these small steps to begin the journey now.
[Originally published at AAPSonline]