There is no practical way to repeal Obamacare…

… so fix what needs to be fixed. 

An early read by the Committee for a Responsible Federal Budget, a bipartisan nonprofit policy organization, says Trump’s plan would both strip 21 million currently insured folks of their health coverage, and add to the deficit.

The group said its analysis indicates Trump’s strategy would “significantly reduce coverage” by creating a system in which coverage became available for 1.1 million Americans, but would not be there for the 21 million who would be directly affected by his repeal of the PPACA.  Source: benefits

No alternative yet presented (by Republicans) as a replacement for ACA is practical and all generally reduce the number of insured Americans while doing nothing to manage health care costs.  And that’s the truth. 

The concepts of market forces, consumer cost driven decision making and competition among insurers is  bogus when it comes to health care. And that too is the truth. Hell,  we don’t even think of health insurance as true insurance. We can’t see any health care expense as affordable. We don’t want to spend one penny on health care … and that is really the truth. 

The Medicare-for-all approach has its own problems of impracticability and costs. 


  1. Your comparison is wrong. You are comparing coverage levels after spending $2+ Trillion of taxpayer dollars. Give me enough money and I too can cover 1/3 of the status-quo-ante uninsured. Was that a good decision in terms of spending taxpayer dollars? Is everyone covered? Is there a better way?

    What we should be doing is creating a system of accountability. Sure, I absolutely agree with you that, ONCE AN INDIVIDUAL BECOMES A PATIENT, “… The concepts of market forces, consumer cost driven decision making and competition among insurers is bogus when it comes to health care. …” But, what you are saying is that any alternative that requires people to fund their own coverage, either through premiums or as part of their total rewards, where people are free NOT to spend their own money on health coverage, is insufficient.

    The problem with PPACA and many Republican alternatives is that there are insufficient incentives in place for individuals to prepare (in terms of health, standard of living, and wealth accumulation) BEFORE becoming a patient. It is here, while Americans are still consumers – BEFORE they become patients, where we are most likely to bend the cost curve and expand coverage. You need incentives to prepare, and coverage just in case there is catastrophic expense (at whatever attachment point you choose). Another area of potential is personalized medicine – in identifying risks before they present themselves as issues, creating the incentives to change health behaviors, and once sick, making the right diagnosis and delivering the customized, correct treatment – the FIRST TIME.

    Today, once you become a patient in our current, someone else pays. The PPACA system, the market forces or economics of health coverage result in an inelasticity of demand – where Americans believe they paid for coverage (employer, Medicare, Medicaid, as taxpayers, etc.) but now, YOU should pay whatever is necessary for my treatment. In that way, I also agree that the current version of health insurance really does reflect your conclusion that: “Hell, we don’t even think of health insurance as true insurance.”

    TOO MANY become patients and because of poor health, a crummy standard of living in terms of poor health choices and insufficient wealth accumulations, they look to taxpayers (read government) to bail them out in the form of an income transfer. People won’t change until and unless behaviors change. People won’t change until the incentives change. The problem with PPACA is that it FOSTERS that result. Health services (through the form of taxpayer subsidized health coverage) becomes a right, an entitlement. You pays whatever fee the bureaucrats assign, and youse then entitled to the coverage.

    So, NO, I disagree strongly with you. Repeal IS necessary if you are going to try to leverage market forces, consumer cost driven decision making and competition among PROVIDERS. The mindset of Americans receiving the welfare/income transfers of PPACA needs to change … change to reflect the mindset of the MAJORITY of Americans – those who are NOT receiving the welfare/income transfers of PPACA because they are covered as part of their total compensation from working… those who are also shouldering the cost burden of PPACS – directly or indirectly. Otherwise, we will continue the existing mindset among some Americans, what I learned in a face to face focus group in Cincinnati, that “I want the best health coverage YOUR money will buy.”

    The logical result of PPACA, as stated by one of its creators, Professor Ezekiel Emanuel, is that all coverage will be sourced through government coverage or the government’s exchange marketplace. He predicted that result would be obtained by 2025. And, maybe, if PPACA had been implemented as written, that would have been the result. Now, I am not so sure. PPACA is a variant of Medicare-for-all – rationed health services based on insurance mandates and bureaucratic decision-making about what is to be covered, who is qualified to receive services, etc. The rationing of services was to be part of PPACA – called the IPAB – starting with Medicare, but, likely extended, directly or indirectly to coverage in the public exchanges. It is America’s version of a NICE system (NICE being the rationing body in England).

    Only the shock of REPEAL will prevent this from devolving closer and closer to single payer. Only the shock of REPEAL, and REPEAL soon, will avoid so dramatically changing the health coverage marketplace so that it becomes a practical and theoretical impossibility to return to a system based on economics and markets, not become a governmental fiat.


  2. This is all just a push to a one payer system run by the government. They do such a good job with the department of motor vehicles, why not. lol.


    1. No, I didn’t miss it. The changes suggested above are certainly practical, just not politically-savvy for Arpege Administrations and Congresspersons – promise em anything to buy votes, and stick future generations with the bill.


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