Repeal Obamacare? Then what?

By Tom Campbell NC SPIN Executive producer and moderator

August 28, 2013

Even its most ardent supporters agree The Affordable Care Act (Obamacare) is flawed, so there is no surprise there is a growing movement to repeal this act most believe won’t cure our healthcare ills and doesn’t contain costs.

But here’s the question: If we repeal Obamacare, then what? A lot of the opposition is political posturing against President Obama, but we’ve yet to hear any of those urging repeal come up with a workable alternative plan that can pass Congress. The repeal of Obamacare without something better presents an even bigger crisis to our nation’s number one problem, healthcare.

Left unchanged our current healthcare system will bankrupt this country. It is unsustainable and more of a threat to our future than the national debt or budget deficit.

America spends more than 17 percent of our gross domestic product on healthcare, a number certain to escalate as Baby Boomers get older, less healthy and need more healthcare. We spend more than twice as much per capita on healthcare than any nation in the world and 75 percent of our spending is to treat chronic diseases, many of which can be prevented. The cost for health insurance coverage for a family of four now exceeds $15,700 per year, a primary reason many employers are opting out of providing health insurance to employees and many individuals, especially healthier young people, choose not to be covered. The cost of providing health insurance benefits to employees does far more to depress corporate profits than taxes.

Most still believe we have the best healthcare in the world. We are the best for specialized medicine like invasive procedures, heart, organ and joint transplants and replacements, cancer treatment and other state-of-the art medicine. But our primary care outcomes are not nearly so good as in many countries. We rank 43rd in infant mortality, 47th in life expectancy and rank in the middle in overall health outcomes. North Carolina ranks in the bottom third of states for health outcomes.

Many say getting government out of healthcare would encourage competition and lower healthcare costs, but there’s little evidence it is or ever will happen. Hospitals, insurance companies, pharmaceutical companies and trial lawyers pay lip service to reforming the system but there are too many dollars involved and nobody is willing to accept fewer of them, so costs get higher and higher with costs shifted to taxpayers and those who have health insurance. Doctors, especially primary care physicians are pretty much prisoners to the system.

When President Lyndon Johnson convinced Congress in the mid-1960’s to begin Medicare for seniors and Medicaid for the poor we guaranteed government involvement and ever-increasing amounts of public budgets. North Carolina spends 22 percent of our budget on Medicaid, with lawmakers constantly forking over hundreds of millions of extra dollars in cost overruns each year. Eliminating or drastically reducing Medicare and Medicaid would result in revolts and riots that would make recent events in Egypt and Greece look like Sunday picnics.

So here we are. A flawed and misnamed “Affordable Care Act,” an unsustainable and seemingly unfixable healthcare system and constantly escalating costs for Medicare, Medicaid and health insurance. We are no fans of Obamacare, but before we throw it out we must have a plausible and more affordable alternative. What’s yours?