Suppose you are a surgeon who is called to see a patient who is bleeding from something in his abdomen. You are to consider an exploratory operation to try to find the bleeding point and stop the hemorrhage.
The problem is that the patient has widely metastatic cancer. He has already mostly depleted the blood bank’s supply of his blood type. His clotting factors have gotten so diluted that it will be hard to control bleeding from surgery. He is already on the brink of multi-organ failure. His cancer is untreatable.
Should you tell the operating room to get ready? You might have a successful operation and keep the patient going a few months longer. Maybe the Obama Cancer Moonshot will have discovered a cure by then.
But almost certainly the patient will either die on the operating table, or a few days or weeks later, during which time some alleged error or complication will have occurred. And the surgeon, without doubt, will be blamed.
The surgeon will most likely decide that the patient is not an operative candidate. If unwilling to say so, he might just send the patient for more tests until the inevitable makes the question of surgery moot.
Now the Trump administration and the Republican Congress is faced with a crisis in the Affordable Care Act. Most of the co-ops are gone. A large portion of the exchanges have only one plan to “choose” from. The money appropriated for shoring up insurance companies that experience losses is used up, and the administration’s illegal attempt to take money from other sources such as the Judgment Fund has run into a court challenge.
The patient named ACA has been in trouble since the beginning, but Dr. Obama has intervened unilaterally to save it with exemptions for powerful players (such as some big companies and a “small business” comprised of congressional staffers) and other types of executive finesse.
But now the Republicans are about to take charge. They have been promising, and dithering, and delaying, and gesticulating about using the power of the purse to stop this Democrat-created disaster since 2010. But now the whole health system is in trouble as ACA tentacles are deeply entwined in it, and millions of patients are counting on ACA health plans. Whatever Congress does will have complications, and if the bipartisan fix or replacement has Republican fingerprints, the Republicans will be blamed.
A number of Republican ideas have been floated, and the differences between them are not trivial. Repeal the new taxes, or keep them but redistribute the takings in a different way? Restore hundreds of billions in Medicare cuts, or keep them in order to stay “revenue neutral?” Get rid of the individual mandate, or admit that without increasingly heavy coercion, young and healthy people will not pay the enormous premiums needed to subsidize the chronically ill? The very popular protection for people with pre-existing conditions will inevitably destroy insurance.
At this point, the Republican Congress might be best advised to continue doing what it does best: keep talking. Send the patient for more tests.
But the nation’s economy, the medical system, and our patients must be freed from the grip of the [Un]affordable Care Act. That monster must die—of its inherent disease, which was created solely by Democrats. Congress, if it can’t do something right, needs to do nothing.
It’s up to the executive branch to embrace its constitutional duty:
- Stop illegal actions that have been resuscitating ACA and permitting its cancer to spread;
- Stop enforcing unconstitutional law; and
- Reverse the regulations that are blocking the development of better alternatives.
Trump could take these actions immediately:
- Withdraw the administration’s appeal of the lawsuit that prevents funding insurers without congressional appropriations (U.S. House of Representatives v. Burwell);
- Order the IRS not to enforce the individual mandate;
- Repeal regulations that require a comprehensive benefits package, and allow insurers to offer low-cost plans;
- Greatly liberalize requirements for Health Savings Accounts.
Those who like their Obamacare plan could keep it—they just couldn’t force younger, healthier subscribers, or current and yet-unborn taxpayers to pay for it. But once allowed to escape from bureaucratic restraints, most Americans will choose something better.
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. Since 1988, she has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fourth editions of Sapira's Art and Science of Bedside Diagnosis published by Lippincott, Williams & Wilkins. She authored books for schoolchildren, Professor Klugimkopf’s Old-Fashioned English Grammar and Professor Klugimkopf’s Spelling Method, published by Robinson Books, and coauthored two novels published as Kindle books, Neomorts and Moonshine. More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.
