What Most Needs Repealing and Replacing

Tomorrow night the House of Representatives will debate the repeal of the Patient Protection and Affordable Care Act (ACA), what many call “ObamaCare.” Some critics complain that this is a futile exercise because there is little chance of short-term success. But that’s the wrong way to look at it.

At the time of its passage, most members of Congress had no idea what was in the ACA. Nancy Pelosi was more correct than she realized when she said, “We have to pass it to see what’s in it.” Even now, we don’t know half of “what’s in it,” but we know enough to have an intelligent debate. Ideally, tomorrow night’s proceedings will be educational — in a way that the debate last spring was not.

In anticipation of the event, representatives from the National Center for Policy Analysis, the Heritage Foundation, the American Enterprise Institute, the Cato Institute and the American Action Forum will conduct a briefing on Capitol Hill tomorrow at noon. Our goal: to discuss ten structural flaws in the Affordable Care Act. We believe each of these is so potentially damaging, Congress will have to resort to major corrective action even if the critics of the ACA are not involved. Further, each must be addressed in any new attempt to create workable health care reform.

1.  An Impossible Mandate

Problem: The ACA requires individuals to buy a health insurance plan whose cost will grow at twice the rate of growth of their incomes. Not only will health care claim more and more of every family’s disposable income, the act takes away many of the tools the private sector now uses to control costs.

Solution: 1) Repeal the individual and employer mandates, 2) offer a generous tax subsidy to people to obtain insurance, but 3) allow them the freedom and flexibility to adjust their benefits and cost-sharing in order to control costs.

2.  A Bizarre System of Subsidies                           

Problem: The ACA offers radically different subsidies to people at the same income level, depending on where they obtain their health insurance — at work, through an exchange or through Medicaid. The subsidies (and the accompanying mandates) will cause millions of employees to lose their employer plans and may cause them to lose their jobs as well. At a minimum, these subsidies will cause a huge, uneconomical restructuring of American industry.

Solution: Offer people the same tax relief for health insurance, regardless of where it is obtained or purchased — preferably in the form of a lump-sum, refundable tax credit.

3.  Perverse Incentives for Insurers

Problem: The ACA creates perverse incentives for insurers and employers (worse than under the current system) to attract the healthy and avoid the sick, and to overprovide to the healthy (to encourage them to stay) and underprovide to the sick (to encourage them to leave).

Solution: Instead of requiring insurers to ignore the fact that some people are sicker and more costly to insure than others, adopt a system that compensates them for the higher expected costs — ideally making a high-cost enrollee just as attractive to an insurer as low-cost enrollee.

4.  Perverse Incentives for Individuals

Problem: The ACA allows individuals to remain uninsured while they are healthy (paying a small fine or no fine at all) and to enroll in a health plan after they get sick (paying the same premium everyone else is paying). No insurance pool can survive the gaming of the system that is likely to ensue.

Solution: People who remain continuously insured should not be penalized if they have to change insurers; but people who are willfully uninsured should not be able to completely free ride on others by gaming the system.

5.  Impossible Expectations/A Tattered Safety Net

Problem: The ACA aims to insure as many as 34 million uninsured people. Economic studies suggest they will try to double their consumption of medical care. Yet the act creates not one new doctor, nurse or paramedical personnel. We can expect as many as 900,000 additional emergency room visits every year — mainly by new enrollees in Medicaid — and 23 million are expected to remain uninsured. Yet, as was the case in Massachusetts, not only is there no mechanism to ensure that funding will be there for safety net institutions that will shoulder the biggest burdens, their “disproportionate share” funds are slated to be cut.

Solution: 1) Liberate the supply side of the market by allowing nurses, paramedics and pharmacists to deliver care they are competent to deliver; 2) allow Medicare and Medicaid to cover walk-in clinics at shopping malls and other unconventional care — paying market prices; 3) free doctors to provide lower-cost, higher-quality services in the manner described below; and 4) redirect unclaimed health insurance tax credits (for people who elect to remain uninsured) to the safety net institutions in the areas where they live — to provide a source of funds in case they cannot pay their own medical bills.

6.  Impossible Benefit Cuts for Seniors

Problem: The ACA’s cuts in Medicare are draconian.  By 2017, seniors in such cities as Dallas, Houston and San Antonio will lose one-third of their benefits. By 2020, Medicare nationwide will pay doctors and hospitals less than what Medicaid pays. Seniors will be lined up behind Medicaid patients at community health centers and safety net hospitals unless this is changed. Either 1) these cuts were never a serious way to fund the ACA, because Congress will cave and restore them, or 2) the elderly and the disabled will be in a separate (and inferior) health care system.

Solution: Many of the cuts to Medicare will have to be restored. However, Medicare cost increases can be slowed by empowering patients and doctors to find efficiencies and eliminate waste in the manner described below.

7.  Impossible Burden for the States

Problem: Even as the ACA requires people to obtain insurance and fines them if they do not, the states will receive no additional help if the estimated 10 million currently Medicaid-eligible people decide to enroll. Although there is substantial help for the newly eligible enrollees, the states will still face a multibillion dollar, unfunded liability the states cannot afford.

Solution: States need the opportunity and flexibility to manage their own health programs — without federal interference.  Ideally, they should receive a block grant with each state’s proportion determined by its percent of the nation’s poverty population.

8.  Lack of Portability

Problem: The single biggest health insurance problem for most Americans is the lack of portability. If history is a guide, 80% of the 78 million baby boomers will retire before they become eligible for Medicare. Two-thirds of them have no promise of postretirement health care from an employer. If they have above-average incomes, they will receive little or no tax relief when they try to purchase insurance in the newly created health insurance exchange. To make matters worse, the ACA appears to encourage employers to drop the postretirement health plans that are now in place.

Solution: 1) Allow employers to do something they are now barred from doing: purchase personally-owned, portable health insurance for their employees. Such insurance should travel with the individual — from job to job and in and out of the labor market; 2) Give retirees the same tax relief now available only to employees; and 3) Allow employers and employees to save for postretirement care in tax-free accounts.

9.  Over-Regulated Patients

Problem: The ACA forces people to spend their premium dollars on first-dollar coverage for a long list of diagnostic tests. Yet if everyone in America takes advantage of all of the free preventative care the ACA promises, family doctors will be spending all their time delivering care to basically healthy people — with no time to do anything else. At the same time, the ACA encourages the healthy to over consume care, it leaves chronic patients trapped in a third-party payment system that is fragmented, uncoordinated, wasteful and designed for everyone other than the patient.

Solution: 1) Instead of dictating deductibles and copayments, give patients greater freedom to save for their own small dollar expenses in health savings accounts, which they own and control; and let them make their own consumption decisions. 2) Allow the chronically ill access to special health accounts, following the example of Medicaid’s highly successful Cash and Counseling program, which allows home-bound, low-income disabled patients to control their own budgets and hire and fire those who provide them with services.

10.  Over-Regulated Doctors

Problem: The people in the best position to find ways to reduce costs and increase quality are the nation’s 778,000 doctors.  Yet today they are trapped in a payment system virtually dictated by Medicare. The ACA promises to make this problem worse by encouraging even more unhealthy government intervention into the practice of medicine.  

Solution: Providers should be free to repackage and reprice their services under Medicare. As long as their proposals reduce costs and raise quality, Medicare should encourage resourceful, innovative attempts to create a better health care system.

Comments (60)

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  1. Neil H. says:

    Excellent post. Thorough and convincing.

  2. Vicki says:

    Very good. Glad to see the think tanks are geting together on message for a change.

  3. Bruce says:

    It all needs repealing and replacing.

  4. John Goodman says:

    Here’s Ezra Klein at the Washington Post, explaining that no one really knows at this point what insurance we will all be required to have:

    http://voices.washingtonpost.com/ezra-klein/2011/01/regulations_not_repeal_votes_w.html

    It’s amazing how much power has been left in the hands of regulators.

  5. Harry Cain says:

    These are mostly constructive ideas for change, but two need lots more work. #3, the problem described is what the risk-adjustment system via the Exchanges is supposed to “solve.” Does this criti

  6. Harry Cain says:

    (cont’d; sorry I hit a wrong key!) Does this critique imply that risk adjustment systems are worthless? And is #4 the problem is well described, but the solution is most unclear, vague. Lots of luck with the briefing!

  7. Steve Hyde says:

    Excellent concepts, if a bit overcomplicated in terms of actionable specifics. All 10 goals can be accomplished in a more straightforward manner with the American Choice Health Plan described in my book, “Cured! The Insider’s Handbook for Health Care Reform” (2009, Hobnob Publishing). It includes an updated version of John Goodman’s inspired health savings account concept. Keep up the good work! Stephen Hyde

  8. John Goodman says:

    Harry, risk adjustment is always crude and often wrong. A better approach is John Cochrane’s proposal — linked to in the text — to allow the market to determine the extra (risk adjustment) fees.

  9. Blake Woodard says:

    John –

    You left off the number one flaw in the ACA –- it should be at the top of your list: The Medical Loss Ratio (MLR) rules. (I can see MLR implied in one of your top 10 items, but you need to mention it specifically). To keep my argument brief, the MLR rules place harsh, impossible restrictions on the wrong side of the battle in controlling health care costs –- the payers –- and give an incentive to the spenders (doctors, hospitals) to spend even more money. Maybe we could call the MLR rules the Barney Fife policy –- limiting your deputy to only one bullet.

    I am very knowledgeable about the MLRs, which were the sole target of my lobbying efforts in 2009 and 2010.

    Blake

  10. Devon Herrick says:

    There are a series of unrelated problems.

    1. An Impossible Mandate
    2. A Bizarre System of Subsidies
    3. Perverse Incentives for Insurers
    4. Perverse Incentives for Individuals

    These problems all pertain to a poorly-designed system that attempts to require people to have coverage (and insurers to cover all that apply) and the subsidies so moderate income families can afford that coverage.

    5. Impossible Expectations/A Tattered Safety Net
    6. Impossible Benefit Cuts for Seniors
    7. Impossible Burden for the States

    These structural problems all relate to the unsustainable nature and inadequate access for those enrolled in public coverage.

    Then there are the problems of efficiency and quality. These two fundamental problems were also not addressed by the ACA in any meaningful way.

  11. Greg Scandlen says:

    I would add an 11th problem — overtaxed citizens. There is a widespread belief that anyone who spends more than a certain percentage of income — usually 10% — on health care is “overburdened.” But there is no similar concern for how burdened the same people may be by taxes. For some reason it is okay to pay very large percentages of income on taxes, but not on health care.

  12. Joe Barnett says:

    Howard Dean is encouraging employers to drop their health plans. The more people who participate in the exchanges, the higher the cost, and the greater the pressure to move to single-payer.

  13. steve says:

    I remain puzzled. How do you propose to preserve physician fees while cutting Medicare spending?

    Steve

  14. Linda Gorman says:

    Steve, experiments in the private sector and Medicaid show that getting the incentives right through consumer directed health care can reduce spending by 10 to 30 percent without imposing any sort of price controls.

  15. Madhatter15 says:

    No one gets it yet we don’t want it, let them fix up medicaid for people who have no insurance, bail out medicare and leave the rest of us alone. If they Repubs can’t repeal it why did they say they could? I would also like to know why no one mentions the Law of the Seas Treaty, Obama signed that and no one was there when he did, one person could have stopped it, same with the Farm act, the worse bill ever, bad food and bad medicine and no water, what a mess and no one to help us.

  16. John J. Faso says:

    John,

    Thanks for your consistently great information.

    John J. Faso,
    former minority leader of the NYS Assembly and republican candidate for governor of NYS in 2006

  17. Carl Dahlman says:

    Good stuff, but it would be even better if it included the legal argument that Obamacare is unconstitutional for three different reasons that serious legal scholars have articulated: the individual mandate is unprecedented in Supreme Court decisions and not founded in the Constitution; the mandated Medicaid expenses by the States are not constitutionally valid under the general welfare clause; and the detailed regulations imposed on the insurance companies turns them, effectively, into regulated utilities, which is a taking in violation of the 5th amendment.

    I think it would be very helpful if the House were to pass a Sense of Congress resolution that simply stated that the Obama act is unconstitutional. This would send an important message to the Supreme Court.

  18. steve says:

    @Linda- For a short time period or in circumscribed areas. I am less sanguine about the long term. Regardless, if docs see a 30% reduction in what they receive from Medicare, as you claim, why will we continue to see Medicare patients.

    Steve

  19. Dr. Steve says:

    First definitions.
    Medical care. We have a great medical care system. It is in jeopardy by this legislation. Medical personnel and facilities provide medical care.
    Health care. What is that? I don’t know, but one’s health is largely one’s own responsibility.
    Confusing the two leads to the wrong expectations.

    Regarding how much we spend on medical care as a society I think we have to look at our standard of living. Because we until recently have had an ever improving standard of living we have had to commit less on necessities, food, shelter, energy, etc. This has allowed more indulging on elective medical care. Hip prosthesis surgery, unless for a fracture and some other indications, is elective. One may not like to admit that, but it is true. That is not to say it is wrong or that it is not worthwhile. But reevaluating expenditures in this context and creating a “free market” in medical care will go a long way to reducing prices.

  20. The Health Care debate was about the spiraling cost of health care that we can no longer afford. The irony is the vast majority of focus has been put on health insurance companies, who make up only 20 to 25 % of every health care dollar spent. The driver of cost is the provider, not the insurance companies. What is the cost of a hip replacement surgery? Gall bladder surgery? Rotator cuff? No one knows. The health care market has never been a free market. Until it is, costs will never be reigned in.

  21. Linda Gorman says:

    Steve, the savings I was talking about have been seen in the private insurance sector and in Medicaid Cash & Counseling type programs.

    If people voluntarily start spending less on health care when they are liberated from stupid bureaucratic controls or have more of a stake in spending less (in one example, people who needed attendant care saved a bundle because they were free to train and hire laymen rather than being forced to hire registered nurses through a Medicaid agency) then we will see less of the activity that they spend less on.

    The savings may, but won’t necessarily, come out of physician visits. They could also come from cuts in oversight, monitoring, and middlemen. Or from a reduction in fraud, wasted prescription drugs, and unnecessary auxilliary services.

  22. Beverly Gossage says:

    We need to be careful that we aren’t focusing on certain pieces of the legislation that we want to repeal and debating over how to amend those, when we should be resolute to repeal the entire legislation, starting with defunding any implementation.

    I would think that those who favor a single payer system would be happy to make some concessions and pluck a few parts out of the law knowing that the law would still stand and HHS will continue to write requirements. Picking pieces out of this bill is like picking mold out of a tainted pot of stew. It may look more appetizing, but it could still kill you.

  23. wanda j. jones says:

    John:

    A major short-coming of this bill is that it ignores the coming deluge of new Medicare recipients of the Boomer generation. This will add to costs while removing their taxes from the revenue for Medicare and remove their professional services from the health system’s capacity to care for Medicare and Medicaid, new enrollees and the private sector patients. There is no way that this additional demand can be off-set by mere adjustments to quality and efficiency. What we need is redesign of delivery, not tinkering with payment. Not only that, the full cost of the new government infrastructure has not been laid out in all its unaffordable glory. Moreover, there is total silence about the dead weight of healthcare unions, who restrict innovation, cost-savings and modernization of patient care. Wonder why.

    Whether the bill is repealed or not, Congress and the President need to see the context and implications of this bill, rather than seeing it as a stepping stone to universal health insurance. They

  24. steve says:

    @Linda- Yes, saw that study. Hope they follow up to see the long term consequences. What unintended consequences will we see from a lesser level of care? Hopefully none. While I like this idea applied to some chronic care, I dont see it working so well with those who need intermittent care. I also think given the amount of spending physicians control, it is not realistic to expect doc salaries to be unaffected. After all, dont incentives matter?

    Steve

  25. Mike says:

    The new law’s CLASS disability entitlement program will require a taxpayer bailout.

    “programs such as CLASS face a significant risk of failure…”
    “there is a very serious risk that the problem of adverse selection will make the CLASS program unsustainable.”
    “in 2025 and later, projected benefits exceed premium revenues, resulting in a net Federal cost in the long term.”

    Richard Foster, Chief Actuary Centers for Medicare and Medicaid Services

    “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.”
    Senator Kent Conrad (D- ND), Senate Budget Committee

  26. RickM says:

    What about: Section 5210, which creates a COMMISSIONED CORPS AND READY RESERVE CORPS at a cost of $70M over 4 years. What a waste of money and provides zero to better Healthcare!

  27. Chase says:

    Nailed it again John. Good work.

  28. Frank Timmins says:

    Steve mentioned a concern over Medicare and physician participation. Perhaps we should start dealing with the possible reality that Medicare (or any system like it) cannot co-exist with free market health care in one economic system.

  29. Danny W says:

    John, I agree with every thing you have said. But I would add tort reform to your list of things that need to be done. In 25 years of practice, my Neurosurgeon has never been sued, but he still had to pay over $60,000 last year for liability insurance. Many of his colleagues pay much more!

  30. MainStreet says:

    It is great to discuss the many provisions of the Act that need to be improved, however, there is no mention here of the vast bureaucracy currently being set up to oversee and ENFORCE this takeover of 1/6th of our economy.

    The only practical recourse is for the House to defund as many upstart agencies as possible and, hopefully, gain enough support in 2012 to repeal. Then serious free market solutions can be discussed and enacted.

  31. Tony R. says:

    One more solution that I haven’t heard mentioned for a long time, and was not in the 10 Flaws of ObamaCare is: “Tort Reform”. That cost reducing item should be in any new health care reform legislation.

  32. Gail G says:

    The most efficient way to fund and take care of the uninsured is to fund expansion of local county hospitals so they can have triage clinics all around their area — it keeps persons out of the E/R unless the need to be there. The system is already in place and working well — it just needs funding and would require far less funding than any other options currently being discussed. It would become an HMO type of service,based on what the person can afford for the monthly/annual fees. Everyone else should be able to purchase insurance from whomever they choose.

  33. Dennis B. says:

    I am for Tort Reform and being able to buy across state lines. I do have questions though: If Obama Care is unconstitutional would not the replacement bill also be unconstitutional? Would not the government still be putting its nose where it does not belong?

  34. tj says:

    Kill the monster…. NO REPLACE Allow across state lines, tort reform,

  35. tj says:

    Good one Dennis B… unconstitutional as hell

  36. jt says:

    Regulate the lawyers. That is the only way health care costs will decrease. As a practicing physician, I am guilty of practicing “defensive” medicine just to avoid lawsuits. Sick, sad world.

  37. Bob says:

    Why did the Republicans not implement any of this while they had control of congress for 10 years? I don’t like the Democrat’s solution, but I don’t remember the Republicans ever trying to fix the problems.

  38. Tom Bartman says:

    Health Savings Accounts, which put the consumer on the frontlines of questioning and seeking savings in health care costs, should be pushed harder. My understanding is that Gov. Daniels of IN caused the state employee unions to accept HSAs and they ended up liking them. Persuasion is needed to persuade the citizenry to accept something of which they have no experience.

  39. Jimbino says:

    Hell no, John:

    I am a non-believer in insurance and do not want to be forced into subscribing to or in any way subsidizing tax breaks for other folks to buy insurance. To me insurance is a scam just like religion.

    Here’s what’s needed:

    Elimination of all licensing requirements for healthcare professionals as promoted by Milton Friedman.

    Requirement that all healthcare providers post all their prices (services, drugs, devices) on the internet. That’s the info (CPT code, etc) that Medicare, Medicaid and insurance companies now use to pay the bills. Why should this info be hidden from the common folk (I had to file a FOIA request in Texas to get the Medicare payment schedule per CPT code)?

    Prohibition of all forms of price discrimination. Walmart and Home Depot charge all customers the same. Why should hospitals and doctors be allowed to practice price discrimination?

  40. walter wojcik says:

    I think this is a good thing, but only the beginning. It is suppose to be government for the people, not people for the government. No government worker (politicians included) are entitled to more than the people paying for them. Lets put everyone on social security, including the president. We can not give ourselves raises and have to make ends meet without help from anyone else. Because of the way this government is run the dollar is looking more like a paso. Government is way to big today….Give the country back to the people.

  41. Bob says:

    Your ideas are certainly thought out by a LAWYER! THE biggest problem is LAWYERS. Health care malpractice insurance is THE single largest cost to doctors and most of the costs are hidden. Lawyers say there is only about a 2% cost to the system but that is a bald faced lie. Every doctor HAS to have liability/malpractice insurance and so does every other person/entity involved and even that may not protect them these days. Even if a doctor is NEVER sued for anything(unlikely nowadays)he/she must pay big dollars for insurance. Nurses, janitors, hospitals, truckdrivers that deliver medical supplies, clinics, labs and on and on ALL have to be insured to the max or they stand the chance of losing everything they worked and studied for. Reform TORT in a meaningful way(not just as a token) and healthcare will for the most part fix itself.

  42. Briguy says:

    I don’t care what kinds of fines they would come up with, I have NO intentions of paying ANY fines to the already crooked IRS, because I choose to not get healthcare. NO ONE in this country is allowed to tell me what I can, and can’t buy. If I ever received a statement from the IRS telling me I owe $750 or whatever the fine may be because I have no health coverage, I would take that form right to their door steps and BURN it in front of them, like the old draft dodgers of the 60′s burned their draft cards!

  43. Ilene says:

    I live in Massachusetts, and universal healthcare is: expensive, limits doctors, overcrowded ER’s because the illegals who are ‘legal’ in Mass. go to the hospital if they have a hang nail. Lahey Clinic has no specialists per se. Every doctor now is salaried by Lahey. Not good. My monthly payment for the last four years has gone higher than it was before Deval Patrick tweeked the healthcare for the illegals. Need I say more?

  44. Tom H says:

    I believe the ACA does not allow the doctors to accept cash in payment for services, which means that if the government dictated coverage does not include what you need, you can’t have it even if you have the money to pay for it. If it is something fatal, you are dead! There is nothing right about that and no one seems to be talking about this. Doctors should be able to accept cash where insurance does not cover what they need. To me this is something that urgently needs to be changed.

  45. dale ahern says:

    what about all the hidden tax increases in the bill. what about the new tax for if you sell your house? what is this even doing in a health care bill? looks like another compromise to me. way to go newly elected republicans. this is not what we want. repeal all the way. let people keep their employer insurance. shop for health care over state lines to increase the competition. government you have no business in the individual affairs of anyone, especially health. unconstitutional? you bet. 2012 just around the corner. just like being voted in with the last election does not guarantee your future in congress – the american people are still closely watching you to see if you rise up to the challenge of defeating this most radical president ever. state of the union address – how phony was that. you people havent seen enough of the last two years to see what his really agendea is? wake up!!

  46. dale ahern says:

    what about all the hidden tax increases in the bill. what about the new tax for if you sell your house? what is this even doing in a health care bill? looks like another compromise to me. way to go newly elected republicans. this is not what we want. repeal all the way. let people keep their employer insurance. shop for health care over state lines to increase the competition. government you have no business in the individual affairs of anyone, especially health. unconstitutional? you bet. 2012 just around the corner. just like being voted in with the last election does not guarantee your future in congress – the american people are still closely watching you to see if you rise up to the challenge of defeating this most radical president ever. state of the union address – how phony was that. you people havent seen enough of the last two years to see what his real agendea is? wake up!!

  47. Tony A says:

    If 30 to 40% of all current healthcare costs are clearly defined as “defensive medicine”, why is no one advocating tort reform. It would immediately reduce the cost of healthcare by 30 to 40%! Seems to me to be a good start. But then again, we fear the legal profession so much, advocating taking the lawyers out of the system will get us sued!

  48. Guy Brigida says:

    I did not see what happens to the people without insurance who go to the ER. Are they billed for the service or does that get passed on to the taxpayer?
    What about entitlements, do they get free health insurance? How about congress, do they buy it as well. The way I see it is you buy insurance like the rest of us and pay for it or pay the fine and the doctor’s bill as well. That is the only way to do it.
    No one should get it for free and no one should get free health care unless the doctor/hospital wants to right it off.
    Sorry, thats the way I see it.

  49. Mary Jo, RN, CCM says:

    In my work and experience I find the MOST EXPENSIVE medical cases are significantly influenced by stupid/dumb people.

    Nowhere in this article,comments or the ObamaCare bill do we address how we can educate and reward those that work at solving their or others medical issues. USA people are eager to learn and help each other.

    I have developed practical solutions and would be available to share with a person more articulate and influential within the government.

  50. Major Stu says:

    After seeing that over 222 businesses have been granted waivers to the provisions of Obamacare, it occurs to me that the way to de-fang it is to enact legislation to provide EVERY business the opportunity to opt out. Why should the arbitrary bureaucrats of the Obama administration decide who gets to opt out and who gets stuck with it? This is epitome of crony capitalism. Take it out of the hands of the bureaucrats and provide a fair opportunity to each and every business in America. Contrary to ex-Speaker Pelosi (love that term) and her delusion that Americans would love this bill when we learned what was in it, the more we learn, the more we find out why they didn’t want anyone to read it before they voted on it. Give everyone the fair choice to opt out, and gut this monstrosity before it grows.

  51. Edward says:

    Shut this monster down in it’s entirety. It has no place in a free market system. When will we learn? Less government= more personal wealth and freedom.

  52. Gary says:

    The ACA is completely unacceptable, and it must go. We must begin to restore American values before it’s too late. No more unfunded mandates! I’m sure that solving all of the country’s problems looks so easy from Washington where they don’t have to live with the consequences of their decisions. They don’t fulfill the responsibilities that were given to them in the constitution. Now they are taking on powers without first securing the consent of the governed. This must stop!

  53. calcbud says:

    Excellent suggestions, now get mr. boehner to sign on,
    Republicans MUST have ALTERNATIVES!

    This obamacare with 3600 pages with total discretion left up to the ADMINISTRATOR/SECRETARY OF HEALTH/SEBELLIUS IS TOTALLY UNACCEPTABLE! This person will be CREATING SUB-AGENCIES THAT COULD GROW 3600 pgs. TO 36,000 VERY REALISTICALLY!

    THIS IS NOT ABOUT HEALTHCARE, IT IS ABOUT
    1) A SOCIALIST PHILOSOPHY-ONE PAYER SYSTEM–FAILED!!
    2) TOTAL GOVERNMENT CONTROL OVER OUR LIVES!!
    3) A WAY TO SNEAK 15 MILLION ILLEGALS INTO A COVERAGE PAID FOR BY U.S. TAXPAYERS, AND CA. WHICH IS BANKRUPT BECAUSE OF THE ILLEGALS BEING PAID FROM SOCIAL SECUITY AND MEDICARE WHILE TALKING ABOUT DISCONTINUING SENIOR MEDICAL PROGRAMS, AND EVENTUALLY TO BRING THESE 15 MILLION ILLEGALS INTO THE VOTING BOOTH ALSO ILLEGALLY TO KEEP OBAMA FIRMLY IN OFFICE AS FAR AS THE EYE CAN SEE!!

    SORRY 3600pgs. OF OBAMACARE CANNOT BE AMENDED–IT IS TOO MUCH OF A MONSTER, IT NEEDS TO BE DELETED AND SUBSTITUTED WITH YOUR 10 STEP PLAN!!

  54. John says:

    Nice try.
    this is nothing but more deception couched in references to conservative organizations and concepts.
    ObamaCare needs to be totally repealed and yanked out by the roots then replace by free market solutions.
    For a good presentation of the type of free market solutions look to Sally C. Pipe’s book “The Top Ten Mtths of American Health Care: A Citizen’s Guide’

    Encourage your Representatives and Speaker Boehner to stick to an outright REPEAL on ObamaCare

  55. Ann says:

    The healthcare bill should be voted down and should be null and void. Health care should not be taken on by the federal government. It can not take care of what it has now. I think if it were out all together we would get back on track. The hospitals are charging outlandish fees now and are getting away with it because the government is subsidizing it and it is out of hand.

  56. Richard Church says:

    I recently got a statement from Blue Cross showing amount paid for some blood tests. (I have an HSA so I pay everything until I reach my deductible). The amount I paid was about $75, which was the negotiated price for Blue Cross clients. If I had not been a BC client, the lab would have charge nearly $500 for the same procedures.

    This is the problem with health care, there are no market forces constraining how highthe price can go. To a large degree, government “regulation” and programs have made these kinds of wild price variation possible.

  57. Charlie says:

    You have made the same mistake you accuse Pelosi of making! You are attempting to influnce us about Obamacare which you haven’t read yourself! The first question I would ask anyone complaining is, “have you read the bill?” I truly beleive the reason few if any have read the bill is because Obama let the special intrest who supported him write all 2,000+ pages with absolutely no input from the Congress.
    More importantly is you need to go to the bunker with the bill and read if you plan to lead and ask for support!
    I’m on your side as long as we don’t get as stupid as them!
    cb

  58. John Alexander says:

    Where do the uninsured currently receive treatment ? How much does it cost the rest of us? Do you know any under payed Physicians? Who controls the availability of medical graduates? Would the uninsured really use those “tax credits” to purchase medical insurance? (realizing that most uninsured are likely low income producers) Should we stop requiring hospitals to treat the uninsured and instead subsidize more funeral homes ?

  59. Dan Jones says:

    This proposal doesn’t go far enough. Healthcare was 4.5% of GDP before the federal government gradually turned that sector into a Marxist dystopia over the last half of the 20th century. We can never have affordable, efficient healthcare in this country until we restore a free market and competition to that sector. For more on this issue, please see http://www.JonesPlan.BlogSpot.com
    Dan Jones, MD

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