Tuesday, March 21, 2017


"We own it," that's what Rick Santorum, former presidential candidate and senator said with reference to the on-going Republican  proposed healthcare bill to replace Obamacare.

By now we know what the successful aspects of Obamacare (the Affordable Care Act, ACA) are that reflect the lifeline of the ACA as it now stands. 

The successful parts of the ACA include keeping children insured until age 26 and disallowing the exclusion from healthcare plans of persons with pre-existing conditions. On the other side of the ledger, once President Obama dumped the Public Option from the ACA, the greedy doors of the insurance companies swung open to raises in premiums and deductibles. In turn, as the cost of the ACA goes up, attempts to control costs raise their ugly heads.

Chief among these ugly heads is the Independent Payment Advisory Board (IPAB) which effectively, once it becomes operative, will facilitate the rationing of health care. Review of recent healthcare history shows that there was a predecessor to the IPAB known as the IMAB (Independent Medicare Advisory Board) which was deleted from Medicare because of public opposition by Medicare recipients. Unfortunately, a revised version of the IMAB wormed its way into the ACA as the IPAB -- if the ACA is repealed the IPAB goes down with it, unless, unless it is brought back to life by as yet unknown devotees willing to throw grandma under the bus. 

The IPAB's lease on life comes from Sections 3403 and 10320 of the ACA (this writer has sought repeal of both sections for the past 7 years, see articles from The Hill newspaper, 9/16/09, and POLITICO, 12/10/10 and 12/17/10). Once the costs of the ACA reach critical levels, these ACA sections allow the appointment of political operatives whose job will be to regulate costs by deciding which procedures and treatment protocols are too expensive to maintain -- not quite the death panels touted by some ACA opponents but too close for comfort.

At this moment in Congress, the deep divide is how much of Obamacare to keep, if any. It appears that complete repeal without adequate replacement will disenfranchise millions. On the other hand, if Obamacare maintains its lease on life, millions risk losing access to care because they'll not be able to afford the ever rising premiums and deductibles. 

Santorum in Congressional hearings points out that either way the blame or credit will fall upon the Republicans. If the proposed health care law fails, the Republicans risk losing seats in the midterm elections (sad to say how much this aspect rules Congressional thinking). So at the moment here's the scoop: Trump does not want the currently proposed bill to be called Trumpcare since its passage could replace the disastrous aspects of Obamacare with new equally disastrous effects. That's why in the glorious halls of Washington, DC, the current Republican proposal is wryly called Ryancare. 


The Hill newspaper,  Washington, D.C.,  "What Obama should've said about health reform," 9/16/09

POLITICO, "How to Ration Care without Using the R Word," 12/14/10

POLITICO, "I Will Insure that No Government Bueaucrat Gets between You and the Care that You Need," 12/17/10 

The Weinmann Report, "Affordable Care Act and the IPAB," 03/28/12,  (www.politicsofhealthcare.com) 

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