For all you geniuses inside the Beltway, here's how it looks from Real America where we're not drinking Koolaid and trying to breathe in a vacuum:
Stop wringing your hands.
Get off your butts and start working.
Repeal the damned thing and replace it.
It is easier than you're making it look. If you just stop fussing around the outside trying to pick and choose how to approach it, and do what the people who sent you to Washington have said they want to do, you could have this done by July 1st - the start of the next fiscal year. After all, this list comes from me sitting on my butt in my living room for about forty-five minutes, and it makes sense:
1) Set the goals - What Do the American People Want You To Do?
a) Repeal the Obamanation 100%. Rip it out, branch, trunk, root and tendril and send it through the shredder. Leave nothing behind to sprout up somewhere else.
b) Institute protections for people with pre-existing conditions.
c) Make sure that families who choose to can keep their kids on their plans until said kids turn 26.
2) Get started:
a) Again, stop with the hand wringing. We didn't elect you so you can stand in a circle and whine about how hard it is. We voted you into office so you could do this. Now you need to put your faith in us to support you and you need to get the job done. You have about twelve short months to make progress - if we see what you're doing and like it, you've got it made. Keep mucking about and waffling, you'll probably be unemployed come 2018.
b) Get medical professionals and insurance brokers involved - what do they say? What's going to make things better and easier for them to provide the best service and care to the American people?
c) Get rid of the lines, which means amending the Commerce Clause (probably the single hardest thing to do, but you're sharp legal minds - I'm sure you can figure out how to do an end run), so we can buy the insurance we want and need at reasonable cost from whatever state or exchange or whatever we choose to do.
d) Get rid of bureaucratic decision makers who tell us individuals what we have to include in our plans - let us decide what coverage we need. As a sixty-year old woman, I do not need pregnancy coverage or birth control. I do not need pediatric care. I do not need prostate screenings. Make sure that plans offer me a shopping list so that I can pick the coverage that best suits my needs.
e) TORT REFORM!!!! Get rid of the friggin' ambulance chasers who sue over a torn hangnail. If someone suffers a case of medical malpractice, okay - let them sue. People need to make choices for themselves and be responsible for understanding the risks they are taking when they sign up for surgery or medication. It should not be my responsibility to pay for someone else's uninformed decision. And prevent ridiculous awards at settlement time.
Make the settlements reasonable, based on the individual situation. If someone loses wages for 60-years, fine. Take their annual salary (gross), calculate the cost of medical care for the individual based on reasonable life expectancy + 10% and that's the maximum award. Period, end of story.
3) Replacement:
a) Let me pick and choose from any insurer I want from any state in the union. If I can't get an affordable plan here in California, then how about one from Louisiana or Minnesota or Utah?
b) Let me pick and choose from a menu of options. As I said, I don't need pregnancy or pediatric care, so why should a health plan I buy include that?
c) For the people with preexisting conditions, they pay a higher premium than someone who's healthy. Why should people who take care of themselves, who manage their weight, don't smoke or drink, who exercise regularly, get their routine physicals and eat properly pay for the excesses of others? Make people who make unhealthy choices pay for their own damned care.
If they can't afford free-market healthcare, make the individual states set up high risk pools, like those for uninsurable drivers who can't get car insurance from most auto insurance providers. They pay a higher premium but get the coverage they need.
d) If families choose to keep their kids on their plans, fine - make them pay for it on their own. Once the kids get insurance of their own, through an employer or on their own hook, mom and dad's premiums go down - but make them pay for it themselves.
e) Make it possible for me to negotiate my own healthcare costs with my providers or medical group if I choose to, and then my insurer comes into the picture. Why should an insurance company get to pick and choose what doctor or group of doctors I can see? If I want to see Dr. X who participates in Plan 1 because s/he's someone I like and trust, but also want to see Dr. Y who doesn't participate in that Plan but does participate in Plan 2 because they're a specialist in the field for which I need treatment, why should I pay extra?
See? If you just stop dithering and get to work, you can get this done and all Americans will thank you. This took me all of about thirty minutes to write up. I'm sure that you guys, with your brain trust and consultants and PR people can do something just as sweeping.
Did I hit all the points? No. Obviously not. But if you wipe the slate clean, 100% clean and wash it with acid so that even God can't find it, you can start new and fresh and it'll be a lot easier in the long run.
Now do what we sent you there to do - get to work and get it done. The clock is ticking.
Best~
Philippa
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