© David Burton 2017

Healthcare 2017

     The second attempt at a Trump/GOP replacement of Obamacare has narrowly passed in the House of Representatives and now faces an uncertain future in the Senate. On its surface this second bill appears to contain many of the features one might desire in an Obamacare replacement and modifications in the Senate may bring it still closer to an “ideal” health care law.

     The current Trump/GOP healthcare bill is their second attempt to repeal and replace Obamacare. Their first attempt was stillborn. According to estimates from the nonpartisan Congressional Budget Office (CBO), this first “Republican bill to repeal and replace the Affordable Care Act would {have} reduce{d} the federal deficit by $337 billion over a decade but would also leave 24 million more Americans uninsured during that same period.” [Emphasis mine] (Ref. 1) Surprise! This initial Republican plan removed the Obamacare mandate requiring everyone to get health care coverage, thereby providing everyone with the option of not purchasing health care insurance. As a result, not everyone would opt to purchase health care coverage and, as the CBO report said, the number of uninsured would go up. But, this is what freedom of choice means! If you don’t want health care insurance, the GOP plan would not force you to buy health care insurance.

     Note that the report also said that the proposed healthcare plan could save the nation $337 billion over ten years compared with Obamacare. The Republican plan supposedly addressed Americans’ demands to repeal the Affordable Care Act (ACA) which has resulted in “skyrocketing premium rates and decreased coverage choices as insurers fled the market.” (Ref. 2) The ACA has proven to be a pack of expensive untruths and broken promises.

     The Affordable Care Act has proven to be a failure - it needs to go. “Obamacare has limited choices for patients, driven up costs for consumers, and buried employers and health care providers under thousands of new regulations. It forced people into expensive plans they did not want and put the government in charge of one of the most personal decisions families will ever make.” (Ref. 3) Patients, with their doctors, should make their own health care decisions free from government interference.

     The ACA replacement needs to fix the problems that plagued Obamacare from its inception, but, its replacement needs to retain what was good and replace that which was bad. The new plan, which I name “Americare”, should provide insurance for those who otherwise could not afford the cost of health care. “Americare” should provide for coverage of pre-existing conditions under certain conditions and, perhaps most importantly, it should cover catastrophic health care costs. Health insurance should not be mandatory. Those who don’t want to pay for health care insurance should be free to so choose. However, should they require health care, they would be expected to pay for their care, up to the point where the cost burdens become catastrophic. The choice is theirs to make – pay for insurance or take the risk of having to pay out-of-pocket should the need arise.

     With respect to insurance coverage for pre-existing conditions, care must be taken to provide coverage for those who deserve and need it while preventing those who would scam the system from misusing this feature. Consider two hypothetical situations: 1. that of Honest Henry who chooses to have health care insurance and, 2. That of Dishonest David who chooses to not have health care insurance.

  1. Honest Henry takes out health care insurance and pays his premiums each year until one day he develops cancer. At that point in his life, he makes use of his health care benefits. His previous premium payments into the health care system, along with those of other honest Americans covers the cost of his treatments. This is how insurance works.

  2. Dishonest David chooses to have no health care insurance and for several years goes uncovered. One day, he develops cancer and at that point in his life, he takes out health care insurance which pays for the cost of his treatments because the law requires coverage for pre-existing conditions. Dishonest David benefits from the pre-existing coverage requirement in the law while the rest of the Honest Henrys in America are forced to pay the health care costs for health care scammers like Dishonest David. This is akin to someone who never takes out auto insurance until he has an accident and then applies for and gets insurance coverage for the accident.
     This not how health care systems should work and is not how any insurance system can work. No insurance system can survive if there are no insured until the need for insurance arises.

     The cost of health care coverage for those who cannot afford it should not be placed on the shoulders of those who can afford to purchase health care insurance. Instead, federal taxes should be increased to pay for the health care of those who are unable to pay for it on their own. Let individual health care insurance reflect the cost of health care to those paying for the insurance.

     About 22 million individuals currently receive subsidized health coverage. For them, Obamacare’s higher insurance costs are offset by the law’s subsidies. However, that is not the case for another group of about 25 million Americans with unsubsidized individual-market coverage or small-employer plans. Those 25 million are the ones whose experience with Obamacare has basically been “all pain, no gain,” as they have been subjected to significant premium increases and coverage dislocations. “Americare” needs to correct this problem and give relief to those 25 million Americans currently experiencing higher premium and co-pay costs accompanied by fewer choices in health care providers.

     We need medical liability reform. “The nation’s medical liability system is broken, and it has imperiled patient access and imposed tremendous costs on our nation. The current system has forced doctors out of practicing in certain specialties; it has caused trauma centers to close; and it has forced pregnant women to drive hours to find an obstetrician. The current system also has imposed a tremendous burden in unnecessary costs on our national health care system and federal government. Estimates are that the failure to enact meaningful medical liability reform costs our nation’s health care system as much as $300 billion each year.” (Ref. 3)

     “Americare” should once-and-for-all address the issue of medical lawsuits that simply raise medical expenses while lining the pockets of successful ambulance chasers. Medical lawsuits should result in financial damages only when there is clear and unmistakable negligence and/or criminal intent. There should be no reimbursement for pain and suffering. Awards should only cover the actual costs incurred. Suits against drug companies for unexpected side effects or consequences once the drug has been approved by the government should not be allowed. Instead, the government should establish a fund to cover the cost of such incidents and awards from the funds should be made on the basis of actual costs incurred without the need to institute unnecessary and costly court cases.

     A single payer health care system has seemingly apparent benefits along with real drawbacks – one significant negative being the loss of choice in selecting a health care provider. Single health care provider systems are basically socialized medicine. Socialized health care systems exist in countries such as Canada, England, Sweden and numerous others. Socialized health care systems have proved to be a mixed bag. The big benefit is that everyone gets covered. On the negative side are numerous horror stories of unbearably long wait times and mediocre quality. In some countries, citizens have found their socialized health care to be bad enough to cause them to seek medical care at their own expense, either within their own countries or by seeking medical services outside their own countries, frequently here in the United States.

     In truth, the United States has had a single payer health care system for over 200 years – one for veterans. In 1811, the federal government authorized the first domiciliary and medical facility for Veterans. The current veterans’ health care provider is known as the Veterans Administration or VA. Modern veterans’ health care came into being in 1946 under Public Law 293 which established the Department of Medicine and Surgery within VA. The law enabled the VA to recruit and retain medical personnel by modifying the civil service system. By 1948, there were 125 VA hospitals throughout the United States.[4]

     The VA disaster is by now well known. In 2014, it was reported that, “At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.

     “The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor . . .” (Ref. 5) Other failures, coverups, deaths and bad treatment within the VA medical system were uncovered and it does not appear that all the problems of veterans health care have been corrected some 3 years later.

     The VA scandal points out the almost universal failure of any socialized governmental effort to serve the public. For this reason, I am not in favor of “Americare” being a single payer health care system, especially one operated by another government bureaucracy. For more on government run single payer health care, see Reference 6.

     Americans should be free to choose their health care providers. Payment for their health care services should be from insurance, out-of-pocket, or by federal and/or state programs, such as “Americare”, Medicare, and Medicaid. Health care providers should accept any and all such forms of reimbursement.

     Health care costs for seniors are higher than for the younger population. At the same time, seniors are generally retired and have restricted incomes. Seniors rely on Medicare for access to health care and still millions more count on Medicare to provide health security when they reach retirement. Currently, the program is unsustainable and will eventually fail without significant reforms. Medicare needs to be strengthened. “Americare” should address the problem, correct deficiencies in the Medicare program and provide the funding needed to ensure its continuance.

     “Americare” should provide relief to the American business community in terms of the health care coverage that American businesses provide to their employees – especially to small businesses. As a minimum, this means reduced regulation and elimination of bureaucratic red tape.

     Once Obamacare is repealed, the next step “is to let the country move to a patient-centered, market-based system that focuses on citizens and not on the government.” (Ref. 7)

     As the saying goes, “The devil is in the details.” The call above for replacement of Obamacare with “Americare” is merely an incomplete first step toward what is needed. There are a multitude of other considerations and details that need to be addressed. But what has been presented here is a good and necessary start. Obamacare unwisely tried to do much too much at one time and failed miserably. Instead, let’s proceed in a more orderly fashion this time and incrementally implement a comprehensive health care plan over a reasonable span of time. But, let’s get the ball rolling now with the most important items. We need to replace the failed parts of the ACA and begin to introduce the elements of a new plan, “Americare”, with well thought out additions as the needs become apparent. This time, let’s get it right and let’s not rush to create another Obamacare type disaster. What may serve America best is a basic plan now, with additional changes implemented over time as their need becomes apparent and the changes have time to be well thought out and implemented. Let’s remember, our nation was first formed with the implementation of a Constitution and then later improved with several amendments. Rome was not built in a day and it’s probable that a workable American health care system also cannot be developed in a single pass. Obamacare was a glaring example of this truth.

  1. GOP Health Care Bill Could Leave 24M More Without Coverage By 2026, CBO Says, Danielle Kurtzleben,, 13 March 2017.
  2. Fight to save health care bill likely lost cause for GOP, Kimberly Atkins, Boston Herald, Page 10, 15 March 2017.
  3. A Better Way: Our Vision for a Confident America,, 22 June 2016.
  4. History - Department of Veterans Affairs (VA), U.S. Department of Veterans Affairs, Accessed 22 April 2017.
  5. A fatal wait: Veterans languish and die on a VA hospital's secret list, Scott Bronstein and Drew Griffin, CNN,
    23 April 2014.
  6. Single Payer Health Care, David Burton, Article 289, 11 May 2017.
  7. After Repeal of Obamacare: Moving to Patient-Centered, Market-Based Health Care, Curtis Dubay, The Heritage Foundation, 13 October 2013.


  18 May 2017 {Article 290; Govt_70}    
Go back to the top of the page