In the 24 years since the Republicans killed the Clinton single payer plan with an alternative that included a mandate and insurance exchanges, they have yet to present a concrete plan. This has not been for lack of promises or House bills passed to kill Obamacare. They promised "real competition" among providers or insurers or both, coming very soon. According to President Trump this would insure everyone at costs so low "you wouldn't believe!."
The fact is that now that they are in control, Republican rhetoric is meeting reality. They are finally finding that if they want to keep insurance companies from dropping out of the market (which some say is their highest priority), and do what Obamacare does without some its key provisions, any other change will cost consumers more, not less. We now hear words like "repair," instead of "replace," and Trump is now saying change may come as late as next year.
Republicans also want to lower taxes on the rich, but find that the cost of prohibiting exclusions and allowing children coverage to age 26 under Obamacare is paid for with a tax on the rich.
The reality is that to best assess risk and set premiums, insurance companies want a mandate, and to best help individual purchasers find subsidized insurance options, exchanges are necessary. Without these, insurance companies want back-up financial protection from the government.
It is much easier to give Wall Street what it wants than it is to help the poor and middle classes. Rising health care costs combined with increasing wealth disparity makes the health care cost burden disparity even worse. Trump's cabinet pick for Secretary of Health is a physician-congressman who made big money while legislating to help health care companies. All this does not bode well for the average American.
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Dick Peterson
Bloomington
