The Affordable Care Act expands healthcare access in the U.S. but does nothing to control its costs. With its current majorities in Congress as well as holding the presidency, the GOP now owns the healthcare insurance crisis. If the GOP doesn’t get it fixed right, it is almost inevitable that we’ll eventually end up with a single-payer system such as universal Medicare.
I have previously discussed one good way to fix the bill recently passed by the Republican House of Representatives. But today I will take a more general approach proposed by Thomas Miller from the American Enterprise Institute. Mr. Miller says that a replacement for the ACA should emphasize:
- Private markets rather than a bureaucratic system.
- Positive incentives to obtain and maintain affordable coverage instead of mandates and ever-growing regulations to buy what you don’t want.
- Decentralized decision making by patients, their representatives and state and local officials.
- Lower taxes, higher value choices and clearer rewards for performing better, working harder and acting more responsibly.
- Better targeted subsidies that will ensure generous protection of our most vulnerable Americans.
General principles such as these will end both the individual and employer mandates and allow average Americans a greater choice in how they want to spend their resources to protect and enhance their health.
Conclusion. The ACA has taken us closer to the goal of universal healthcare for all Americans and there can be no retreat from this standard. But much better cost control can be achieved and this is what fixing the ACA should focus on. A free market system for healthcare will work if it is set up in a fair and responsible manner.
It Does Not Add Up 
Well said. I would offer only one detail. The funding should assure the equitable availability of Primary Healthcare that is promoted by the community stakeholders with a commitment to the Common Good for all its citizens.
It seems to me that the Community Health Centers provided for by the ACA will continue to fill this role under any new healthcare plan.
The premise that “free market” health care will work is incorrect. Insurance companies have little control over premiums – the underlying cost of hospitals and doc’s is minimum 70% of the cost. Nobody should be allowed to opt out – they get (at least emergency) health care without insurance – that’s a public service and they need to pay for it. Other services – particularly urgent care – patients are in no position to shop or bargain for price. It is time to begin to consider which universal coverage model to adopt.
In the meantime the current Republican administration and congress are s not even really trying – they desire to use health care dollars to fund a huge tax cut. Not even good faith health care strategy.
I agree that we need to adopt, or at least move toward, a universal coverage model. I think that the final GOP plan will move in this direction.