How To Fix The ACA Now That Trump Has Been Busted

03/25/2017 01:13 pm ET Updated Mar 25, 2017

Okay, the Republican plan, the American Health Care Act (AHCA), was shot down in flames yesterday, and with it Trump got busted for taking all Americans on a wild goose chase given his promises to provide better and cheaper health care while campaigning to become president. With the demise of the AHCA, Americans have reaffirmed that health care is a right for us all. “Health Care As A Right: Republicans Won’t Succeed in Dismantling Obamacare” (March 1, 2017); “Skin in the Game-Why Republicans’ AHCA Bill Should Fail” (March 16, 2017). So now what? Let’s get on with the business of being positive by reforming the Patient Protection and Affordable Care Act, a/k/a the Affordable Care Act (ACA), colloquially, “Obamacare.”

The Republican argument boils down to two main points. First, there is not enough competition to which Americans can look to purchase health care insurance. We need not look any further than to what Obama’s first choice was with the ACA: the Public Option. For those steeped in its history as the ACA was being developed, the Public Option was to take the form of either the government running an insurance company or the government providing the seed money for an insurance company that would offer health care policies for Americans on the individual market. This was met with stiff resistance, principally from Republicans and their supporters like...insurance companies. By having a government-run or government-backed insurer compete in the marketplace of private insurers that participate in the ACA health care exchanges, premium costs would surely do down, and decrease at an even slower rate than the ACA has now done. Again, the Public Option was defeated, so in its place was the individual mandate that requires everyone to purchase insurance or else pay a penalty. Republicans clamored that government should not force anyone to purchase insurance that would cover those less fortunate or unable to buy health care insurance. If so, how would insurers stay in business? As we see, insurers have left certain markets because with the benefits we now expect and receive, certain insurers believed that their profit margin was not high enough to stay given what they had to cover―-again, in certain markets.

As a subset of the Public Option, consideration should be seriously now given to allowing more Americans to participate in Medicare, perhaps by considering participation as young as those 55-65. Of course, years of planning for this will be necessary as it would require employer paychecks to be a little less fat because allowing Americans 55-65 to enter it requires more dollars in the kitty during a phase-in period. Sure, this is suggestive of a single payer, universal health care system, but that may be an end goal that may/may not ever be achieved. As well, as reported elsewhere in the pages of Huffington Post, the administrative costs for Medicare are about 1/3rd as much as any private insurer that offers health care insurance.

Second, if we want to continue to have the benefits provided in the ACA, they must be paid for; it is just that simple. In other words, if we want to have these benefits, everyone needs to participate in the risk, i.e., pay for them by being required to purchase insurance because millions of Americans, particularly seniors and the poor, cannot afford required insurance. Of course, Republicans don’t believe that government should be involved in health care even though on this planet there is not one industrialized country that allows the private market place to provide health care insurance/health care to their citizens without government involvement, or that health care need not be a right. What occurred yesterday is an incredibly strong warning that the philosophical bent espoused by the likes of Ryan, Price, Pence, and Trump is not what Americans want, need or require (recall only 17 percent of Americans liked the AHCA)! Also, insurers have nearly 17 percent (16.8 percent) administrative costs plus a healthy profit margin. Thus, the individual mandate (again recall that they forced Obama to go to the IM instead of the Public Option) became the antichrist of their now defrocked bill. So, while the individual mandate must still be kept, perhaps younger Americans can accept the mandate “better” by being offered plans that are more suited to their state of mind of being healthy and never needing health care insurance.

Third, and this is a biggy, the government must be allowed to negotiate pharmaceutical prices with big pharma. Our medications are just too costly, and needless so―-just go over the border and see what the drugs we pay for here cost there.

Fourth, and this is also a big one, the cost of healthcare in the U.S. is also much too expensive when compared to the same results over our borders. As we have read in recent days, the U.S. ranks 37th in quality and with an average cost per American of over $9,000 compared to less than half of that in other countries.

Fifth, Republicans stumped for selling insurance across state lines. What they don’t tell you is that the ACA already provides for that (Sec. 1333), but insurers don’t want to be involved in that.

Though a complex area to navigate and craft, Americans have an unfettered right to seek and expect health, and since our system is based on an insurance model that is the conduit to carry out this philosophy, Republicans need to get together with their Democratic counterparts and work together to improve the ACA so that benefits within it now remain or are increased with a cost that is lower than what we have now-a-days while still recognizing costs and profits for insurers. No pol, to be sure, wants to get busted again for interfering with our right to health care.

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