Repeal and replace.  This has been the strategy and slogan of the Republican party with regards to TUCA (The Unaffordable Care Act).  By and large what they want to replace it with is another “plan.”  While HSA’s (health savings accounts) would be an improvement (the centerpiece of virtually any Republican plan), I like Yuri Maltsev’s analysis of HSA’s.  He said that if spending pre-tax dollars for health care is a good idea, why not make all spending “pre-tax?”  “Why limit it to healthcare?” 

Here’s a different idea for the Republicans.  Repeal and acknowledge. Acknowledge that government has no role in health care at all, never mind what the central plan looks like.  The idea that one plan could fit everyone everywhere in this country doesn’t make sense to me.  Just as central planners can’t determine pricing, I believe they can’t plan for how people should spend their money and prioritize for them better than the people can themselves.  Just as real prices must emerge from a market rather than be imposed on it, an efficient resource-allocating pattern emerges from a market.  Some bureaucrat’s fantasy imposed on all of us will never work.

If we really wanted to understand the political health care game in D.C. we should suggest the “planning” be put in the hands of the not-so-central-planners….the state bureaucrats.  While this approach still removes spending priorities from individuals, at least the state officials would not be able to print money on the backs of the unborn to fund current healthcare promises to constituents.  Again, I am not recommending this, but corrupt or incompetent local politicians are easier to hold accountable than the national boys and girls and it would be fun to watch the D.C. reaction to this suggestion.

What do you think the reaction to this “turf it to the states” plan would be in D.C.?  You might think they would be happy to wash their hands of this whole bankrupting health care mess, wouldn’t you?  You would be wrong.  We would be inundated with reasons why this would leave people dying in the street, why state bureaucrats weren’t as smart as national bureaucrats and why this would fail.  The feds would fight this like crazy because with the loss of power and control, they would lose their ability to “sell” their services to the folks whose pockets are lined by the laws they create.  I think it would be instructive to float this “turf it to the states” idea just to see and confirm this reaction from the feds.

The big insurance companies and the corporate medical complex have had enormous influence on both parties.  While the Republicans were in complete control, they had every opportunity to show the nation what type of health care solutions made sense to them.  But this corporate influence won then and as long as the power and control remains in D.C., will likely win again.  

D.C. needs to get out of this health care game altogether.  I think that acknowledging  failure might surprise many lawmakers with how politically popular this honest admission could be.  This would be like an alcoholic admitting that he has a problem.  Repeal and replace, on the other hand, would be like the alcoholic switching from vodka to gin anticipating a different result.  I would suggest that a health care plan is something a family should have, not a country.

G. Keith Smith, M.D.