Before The Affordable Care Act will EVER work, we need to first accept these FIVE realities.

     For most of the either years of the Obama Administration, the GOP whined about the Affordable Care Act while shouting their battle cry of "Repeal! Repeal!". This of course over time evolved into "Repeal and Replace!" as the winds of political opinion unexpectedly shifted on them when people realized "You know, it's not necessarily a bad thing to help poor people get health insurance". 

     Now with the new Trump Administration in place, the GOP is in a wind-sprint to get a "replacement" on the table before the end of Trump's first hundred days, (in order to look "zippy" I imagine).  They have thus presented a plan so badly thrown together with duct tape, it never had a chance of being passed and was thus pulled from the table before the GOP could embarrass itself by putting to a vote.  Some 28 votes (or more) in their own party were going to side with the Democrats and reject it.  This current bill can be simply called "Tweak and maintain current course and try to convince everyone this is a Repeal and Replace".  Amazingly still, during Trump's campaign, he continuously railed about the need to allow the insurers to compete across state lines and promised to add that to his "signature replacement". Note now there is NOTHING in regards to that in this new bill. Fortunately there are just enough people in Congress not dumb enough to fall for it this time. Some call this a loss for the GOP. I call it a win. They are finally beginning to stand up to their own crappy leadership. 

     Look, I will go on the record (again) as saying President Obama's heart was in the right place with the Affordable Care Act. I don't agree with the exact structure of his final delivered product nor how he attempted to roll it out but I don't doubt his intentions to fix a problem that DOES exist in this country.

     We have a large chunk of the population with no access to health care when needed. When they are included statistically with the entire middle class and up, it pulls our average life expectancy numbers (in the U.S.) down below most industrialized nations while our costs still remain the highest. It's not unlike our public school system where we spend more per child than almost any other developed country on Earth, yet our test scores are pathetically average, some even below. There is one common theme existing in both problems. That is excessive government regulation and control. The government causes the problems and then wants to be hired as to solve them. This is like hiring the fox to guard the hen house.

     To the disappointment of some naive believers, big government is not a benevolent force of good trying to protect the little guy. In fact it is usually quite the opposite. Most Washington politicians would classify as wealthy. People of lower incomes continuously vote people into office that remain wealthy while they themselves are hardly helped at all. And these people along with their supporters continuously point to everyone except themselves and say "You need to do more (and pay more) to help those people". It's easy to say that someone ELSE should be more charitable while trying to claim the moral high ground. Why do some folks keep feeding this black hole?  If this is ever going to improve, the rest of us here at the grassroots level need to intervene.

     If America truly is ready for a government health insurance program, there is really nothing saying we can't create at least a basic functional program that does what it is supposed to while at the very least breaking even. But any program to have a shred of a chance of success needs to be based on reality and not what a given political movement assumes its followers will do. It also needs to be carefully crafted by a large and diverse team of thinkers; Not just politicians, but also doctors, nurses, hospital administrators, insurers, patients themselves, financial experts, economists, psychologists, analysts, legal experts, the list goes on.  This is a massive project and the government historically sucks at managing projects.  Our federal government literally wastes billions of dollars per year in botched projects, a statistic sadly overlooked by most people.

     They reason for this continual pattern of governmental failure is they lack the same incentive for success as businesses in the private sector do. For the rest of us, failed projects can mean certain disaster in one's career. For the government, their solution is "we need more funding." In which case they'll just confiscate more of your and my money in the form of increased taxes in order to keep their failed project on life support. The only incentive they have is being reelected. If they can pump enough deficit spending into a program to keep it afloat long enough, they're golden and they can pass the problems down to their successor and let them deal with it. The cycle repeats itself.

     I cringed while watching the Affordable Care Act roll out. The federal government was making every mistake in the book. As a project manager by trade, my entire livelihood is dependent upon my ability to make sure a project is rolled out successfully.   And before hitting the "go" button, the idea is to plan, plan and plan some more. It also involves proper "Risk Management". What can go wrong? What might surprise us? What happens if it does? How will we respond?  You plan these contingency responses until you are blue in the face. This is done with teams of people, not small groups of self-anointed subject matter experts of field none of them have ever worked in. 

     There is not one person on this Earth that is intelligent enough by only him or herself to solve the complex problems introduced by the Affordable Care Act or for the problems with our entire health system as a whole.  True, the ACA did in fact help some people obtain health insurance that otherwise unable to before. But this was not without unintended financial consequences that make it mathematically insolvent within a relatively short period of time. It also shifted the costs to other people including the middle class. (This wasn't supposed to happen, remember?) The quick gut-reaction is to yank it entirely going back to how things were before. But how good were they really?

     Conservatives need to accept the fact that social programs are going to be a part of our lives whether we like them or not. The best thing we can do is work to keep them as unobtrusive in our lives as possible, while ensuring the ones we do adopt function efficiently and cost effectively. Unfortunately these are two traits the government won't be accused of having anytime soon.

     Before the GOP can present an alternative that has some teeth, everyone needs to accept some realities.

image from Financial Times

First, everyone needs to understand the difference between health CARE and health INSURANCE. They are not one in the same. Proponents of socialized medicine like to point out that our healthcare system is the worst in the industrialized world. In their defense, they are half correct on that.  Our health CARE system is not the problem despite the cherry picked b.s. data that socialists and other big government pundits like to present. We have the BEST doctors and nurses and facilities and researchers and medical schools on Earth. I'll put them up against anyone anywhere. The problem is the insurance INDUSTRY paired with the government itself. They are the ones that actually suck at this. Additionally, single payer systems in other countries require tax rates of that average in the mid 40 percentile range to well over 50 percent.  Healthcare is far from "free' in these countries. They take it out of your paycheck and then give you something in return. This is no different than if I took $100 from you and then brought you $100 worth of groceries to your door. Sounds nice since it saved you a trip to Safeway but you never got to select which groceries you wanted. Lastly, one frighteningly overlooked statistic that keeps me up at night is how many people in the middle class might lose their houses if their taxes were to jump that highly in such a short period of time. Think about that for a moment. Scary isn't it?

     Second, calling Healthcare a "right" has a fundamental flaw; It implies that one person is entitled to another person's property. And that the government is granted the authority to make sure that exchange happens. In this case the "property" takes the form of an acquired skill. This being the skill that trained doctors and nurses have in order to care for patients. A skill like anything else is a limited resource. The government in theory would have to guarantee that doctors and nurses will provide care to everyone that needs it when and where they need it. That opens the door for forced servitude which we outlawed some years back, remember? It would only be a matter of time before a some people living in a remote part if the U.S. would demand colocated health care providers. But if no caregiver wanted to uproot his or her family and move to the middle of nowhere in order to take that job, now what have you? Some might say "that will never happen". If you allow the government THAT much authority, it WILL happen in some form or another. History shows that they eventually will capitalize on it. Some politician will see it as an opportunity to gain votes; a politician's currency of choice. They stand behind a podium demanding you to give more to someone else and then they try to claim the moral high ground. 

     Third and possibly most critical, we need to reexamine the number of U.S. citizens we used to identify as "without health insurance" before Obamacare kicked in and then break them into TWO categories; first being those that are in true need of help or as I call "tragically uninsured". These are people that have fallen on hard times in their lives, perhaps by bad luck, perhaps by choices. Nonetheless, helping these people is a virtue and I'll stand in defense of the idea of doing so. I'm OK with contributing to their aid. The second group however are those that CAN afford insurance, but simply chose not to buy it due to any number of reasons ranging from procrastination to simply thinking it isn't necessary. You can actually subdivide this further to include another group which is made of people that WERE able to afford insurance, but rather blew the cash on something else. A bigger house than they need, fancier car, premium cable and expensive vacations, etc. I'm sorry but nobody can provide an ounce of logic defending the notion that responsible people should have to pony up extra cash in order to pay for people that make stupid decisions. Both sides of the aisle need to grow spines and tell these people "no" like the children they are. This will force them into making the necessary adjustments in their lives in order to afford insurance. Just because they may not want to get a used car and a smaller apartment, does that mean the rest of us must subsidize their lifestyles? These groups need to be discounted from those that actually need a helping hand. There is plenty of money in the public dole to help those people provided it isn't leeched up by those that don't actually need it. They just jumped into the line with their hands out and politicians, like always, just couldn't say "No".

     Fourth, Conservatives need to understand the "guarantee" of insurance and why people want it. The Right likes to talk about how charity and volunteer groups will take up the slack to care for those that need help if there is no government plan. This in theory could work but will it for sure? Can that guarantee of aid be assured? if even they believe this will work, then I ask those Conservatives "Why do you buy home and car insurance?" The answer is because in life we are willing to pay real money for that peace of mind knowing that the help will be there if needed. We don't want to have to rely on charity if something goes wrong. 


     Fifth, if there is going to be a "mandate", it must be a real mandate. Not a symbolic and optional one. You are required to obtain health insurance of some kind. If you do not, we will assign the basic government plan to you and we will charged an additional tax for it.  If you cannot afford it, you will quality for Medicaid. The provided plan will not be a Rolls Royce plan. But it will get you by. If you have a condition or become gravely ill or injured, you'll get treated and won't go into the poor house.

     Some Americans love to point to European countries whose economies and GDPs we out perform and say "We need to be like them." My answer is "Why?" There is a reason we broke out of the European model of governance two centuries ago and walked our own path to prosperity. American has always found a better way of doing something. There is nothing stopping us from doing that yet again with the health care (and insurance) industry. Well, aside from political stubbornness of course.