Obamacare repeal advocates haven’t offered good alternatives

By Michael Pramenko

“If you like your health insurance, you can keep it.” These words will continue to be played over and over again in 2014, as health reform remains a major political football.

The fight over Obamacare has consumed politics for the last four years. And, being an election year, 2014 promises to be no different.

There is no question that President Barack Obama took it on the proverbial chin with the initial failed roll-out of the federal government’s health care exchange. Certainly, several of the state-run health care exchanges had similar difficulties. For example, Oregon’s state-run health exchange is still limping along and Maryland’s might need major reconstructive surgery. 

Given the troubled roll-out and sudden loss of insurance that many individuals experienced as their non-grandfathered health plans were dropped, political scorekeeping would certainly grant some momentum to the anti-Obamacare politicos.

Nevertheless, as a physician and a student of health policy, I’m still frustrated by the lack of detail from Obamacare critics with respect to their “repeal and replace” policy.

Sure, I’ve heard about selling insurance across state lines and plans for reducing defensive medicine. But, these ideas still leave the uninsured and under-insured without the consumer protections that Obamacare provides.

To truly address the problem, one must separate the politics from the policy — a nearly impossible task as most Americans now view health reform through a political lens foisted upon us by the media. That is unfortunate. Patients rely on policy — not politics.

✔ Current policy under Obamacare now allows people with pre-existing health conditions guaranteed access to health insurance.

✔ Current policy outlaws lifetime caps on how much insurance companies will pay when a patient is faced with a catastrophic health problem.

✔ Current policy, to date, has now enabled over 2 million Americans to be covered by private health insurance via Obamacare. Expanded Medicaid covers many more.

✔ Current policy does not allow health insurance companies to sell junk insurance policies designed more for their shareholders than for the patient.

What might seem like a wonderful political football in January may look entirely different when the leaves turn color this fall. Over the course of this year, millions more Americans can and will sign up for health insurance.

By Election Day 2014, repealing Obamacare would mean revoking the insurance coverage for millions of Americans. And in this case, it will not be because of grandfathered-verus-non-grandfathered health insurance policies.

For conservatives, repealing Obamacare will intentionally, and with great exuberance, remove folks from their health insurance or Medicaid.

Seriously, it appears many conservative candidates will be campaigning this year to make sure that many Americans do not have health insurance. With some Americans having private insurance for the first time in their lives, it seems an awkward political stance. For some Americans who have pre-existing health conditions, it seems borderline immoral. Have party leaders thought this out?

Apparently not. Now, nearly four years after the passage of Obamacare, Americans are still left wondering what exactly the plan is for replacement after the repeal. After repeated Republican House votes to repeal Obamacare, there has not been one vote cast on a replacement. Aside from several “band-aid” proposals, we have not been presented a true choice from conservatives regarding comprehensive health system reform.

Meanwhile, our leaders could be working together to make Obamacare work better by filling coverage gaps, instituting cost-control measures and addressing defensive medicine.

So, as we continue this debate into the next cycle of elections, I would encourage thoughtful voters to ask candidates what their alternative plan would be to Obamacare. It’s not an easy task. A genuine alternative, allowing for coverage of pre-existing conditions for those previously uninsured, is not simple policy and it is not simple politics.

For now, we must assume that the “repeal” proponents favor pre-Obamacare insurance industry tactics. And, for now, the politics that defines much of conservative policy on health care could be stated as: “If you like your new health insurance, we’re trying to repeal it.”

Michael J. Pramenko, M.D., is the Executive Director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is a Past President of the Colorado Medical Society.


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Dr. Pramenko, I guess the Obamacare talking points memo you took your information from did not include this gem:  http://www.foxnews.com/politics/2014/01/22/administration-fears-part-health-care-system-so-flawed-it-could-bankrupt/

PART 1. I do not respond to Pramenko directly or personally. Such self-serving sophists aren’t interested in truth, logic or learning. Their ill-disguised attitude is: “Bend over, America, Obamacare is coming! If you don’t like it, we’ll just diagnose you to suffer from ‘persistent delusional disorder’ (previously known as truth and logic) and stick you in a FEMA ‘reeducation’ camp somewhere.”
I respond generally and ideologically to defend truth, logic, self-ownership and the freedom to acquire knowledge with the same determined persistence that obnoxious zealots like Pramenko use to defend their simplistic and deceptive fascistic Big Brother propaganda BS regarding personal choices in health care.
Basically, Obamacare is a dead issue. So live with it. The American public is not buying the fascistic mathematical fraud. Not enough people are signing up, especially not the healthy young people the fascistic social engineers had in mind when they concocted Obamacare to increase the profits of insurance companies by creating a captive market.
As merely one human being, Pramenko needs to get over himself. He simply oozes narcissistic elitist arrogance. Allopathic establishment docs represent only a tiny part of the overall health picture, but to hear Pramenko tell it, they are Gods in white coats which the rest of us “lower-form-of-life” normal folks could not live without. That’s simply a self-serving crock which has been allowed to be perpetuated by the UNsustainable commercial monopoly on pain control which the AMA’s powerful lobby was able to wrangle out of its “crony-capitalism” (aka “fascism”) cronies in Congress. But it does explain why the AMA and their toadies in the FDA would love to gain total control over vitamin and mineral supplements — if we let them.
Truth is, lots of people have proposed alternatives to “OKenyancare”. Libertarian presidential candidate, Dr. Mary J. Ruwart has pointed (http://bit.ly/19XjIV7) out that health care costs could be reduced by some 80% overnight by simply abolishing the FDA and opening up competition in pharmaceuticals. I and numerous others have recommended adoption of a Freedom of Self-Medication Amendment to the U.S. Constitution which would undermine the allopathic establishment’s commercial monopoly on pain control by giving the individual legal access to all the same tools and meds that licenses physicians use — SOLELY for purposes of doctoring oneself, NOT third parties. As many self-ownership advocates have pointed out, 95% of what doctors do in their offices, we could do for ourselves, if given the legal opportunity. Of course that would mean Pramenko et ilk would make less money, and we can’t allow that, can we?
Interested persons can read my proposed Freedom of Self-Medication Amendment at http://bit.ly/1azgroE.

PART 2. The simple truth and logic of Economics 101 should be endlessly repeated: the ONE AND ONLY defense an individual has against the price of something (such as Pramenko’s services) being too high is the constitutional right/freedom to not buy the product or service. We forget that universal truth at our own peril.
We need to remember that the U.S. Supreme Court has lied to the American public on several occasions to benefit the debt-as-money oligarchs. See such cases as M’Culloch v. Maryland, 17 U.S. (4 Wheaton) 316 (1819), Legal Tender Cases (Knox v. Lee, Parker v. Davis), 79 U.S. (12 Wallace) 457 (1870) and Juilliard v. Greenman, 110 U.S. 421 (1884). Compare those revisionist history lies to the truth of Hepburn v. Griswold 75 U.S. (8 Wallace) 606 (Feb 7, 1870). The only difference was that Ulysses S. Grant took advantage of his opportunity to change the membership on the high court.
Understanding that, it should not be too difficult to understand that Chief John Roberts lied to the American people when he said that it was constitutional for the federal government to be able to force citizens to buy a product (e.g. health insurance) so long as we torture the English language and call it a “tax”.
Lest some folks would pretend that what I have said here is “radical” or “unkind”, or “politically incorrect”, I would remind them that numerous public personalities (legal scholars among them) have said substantively the same thing in even harsher terms.
We are in a so-called “Culture War” for the soul of America. We are fighting for the survival of constitutional self-ownership and self-determination. With that in mind, I would remind any critics that, to paraphrase Barry Goldwater, “extremism in defense of liberty is no vice ... and moderation in the pursuit of justice is no virtue.”
For Pramenko to boldly proclaim that no one has offered any alternatives to Obamacare, in plain English, “just ain’t so.”

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