Repeal but not replace: "... we should reject ObamaCare in totality, and 'replace' it not with additional government, but with no government at all."(Medicine & Health) (Patient Protection and Affordable Care Act)

• Author: Emord, Jonathan W.
• Position: Medicine & Health

The Republican leadership in the Senate agonizes over how best to "replace" ObamaCare, thus starting with a flawed premise which is bound to fail. Based on the paternalistic and freedom-depriving notion that it is for the government to compel the individual to obtain insurance and it is for the government to dictate the kind of insurance available to all, ObamaCare invariably leads to market distortions that increase cost; government-influenced or -mandated allocation of medical resources that rations care; a government-centric rather than patient-centric system; and near universal disappointment and inadequate care.

The business of insurance is one of careful measurements of risk dependent upon a myriad of factors, which nonetheless leaves ultimate care decisions to patients willing to pay and doctors willing to perform. An effort to impose a one-size-fits-all standard on health insurance thus alters not only the make-up and cost of insurance (limiting options and increasing costs), it delimits medical practice, which must bend to accommodate insurance demands regardless of medical realities and professional preferences.

So, when the Republican leadership presumes to keep ObamaCare in place in part and tweak it, or diminish its scope but infuse it with funding to keep it on life support, it is embarking on no less than mission impossible, as an anti-market, government-run paternalistic health care system never can be successful.

There is a principled alternative to ObamaCare appeasement, one that removes top-down, government dictation of health insurance and health markets and replaces that state paternalism with a patient-centric system replete with freedom of choice. As in most all things, the central question is who exercises ultimate freedom to determine whether and to whom dollars enter the health care system: is it the government by insurance company proxy or is it the patient in each individual case? There is no way to retain any element of ObamaCare and revivify a patient-centric system where market forces prevail over government mandates. Consequently, ObamaCare must be repealed completely, leaving none of it.

The sequence of overall legislative events germane to this issue is backward. Tax reform should have preceded ObamaCare repeal and replace, because the ultimate...