Repeal & Replace Not So Ez!

While Obamacare is significant in terms of being emblematic of a failed two-term presidency, in practical terms it is best understood when one considers it (ACA) to be the final nail in the construction of a coffin that began decades earlier. From Roosevelt who wanted a national healthcare system as part of his Social Security plan thru each attempt, by successor administrations, all the way to LBJ’s Administration that, in July of 1965, finally signed Medicare into law including each modification/expansion that occurred thereafter.

Routinely, government programs originate from noble intentions and yet they fail under the weight of political-advantage with equal routine primarily because these programs become mechanisms for delivering political gain/advantage. They fail not because their cause is unsustainable or perhaps even rational, they fail because they move beyond their initial purpose imposing a demand the system was never designed to fulfill. In fact, they become unworkable, politically, and structurally insolvent and wholly irreconcilable with sustainable economic principles. This simple statement pretty much describes why government is incapable of managing any program of fiscal significance and why allowing it to do so should be prohibited.

Obamacare simply extended the consequences of governments tendency toward mismanagement (and overreach) in two key areas with one significant result:

  1.  ACA destroyed the market-based premium matrix and risk-pool; the relationship between what coverage (premiums) provides and the qualitative relationship of costs as it relates to the insured (the “risk-pool”) it covers.
  2.  It removed the barrier between market-based care/coverage and Government-run/subsidized programs.

Government doesn’t concern itself with cost-efficiencies, it delivers political promises and then obligates the taxpayer to pay for it. We observe the consequence of this systemic failure by way of chronic deficits, unfunded liabilities and massive government (Federal & State) debt-loads.

The significance of all this is that the delivery-infrastructure, the Doc’s, Hospitals, Pharmaceuticals etc. (i.e., the entire medical system) has morphed into an appendage which shape-shifts itself in response to a government-run matrix, a broadly manipulated and subsidized environment where billing and cost recover techniques are far more important than the quality of care, service and market responsiveness. Once the market-based business curriculum is removed from private enterprise all that remains is Demand (what government wants) and the inefficiencies of the follow-on structure that finds ways to recover the costs of fulfilling Demand including as much of the Profit they can design into the cost-recovery mechanism.

You have no fallback position with government-effects consequence such as this due to the fact that there’s no longer a mechanism or desire for economic accountability or policy effectiveness as the entire structure is now co-dependent and in stand-off mode. On one side you have the delivery-infrastructure responding to what the Government Demands and on the other side you have the Political Apparatus that will never confess its abuse and ignorance and then, behind all of this, you have the Public that’s been drawn into the allure of something-for-nothing expectations as an unalienable human-right; from here the system spirals out of control.

What makes Obamacare so difficult to Repeal & Replace is simply this: The political-apparatus of government, and the Publics addiction to it, has completely destroyed the link between form and function and there’s no facility for tracing a route back to the point where departure-from-reason occurred. To go forward, an entirely new architecture, if one intends to do it correctly, will need to be designed and constructed in an environment where the co-dependency of political-advantage and the Publics irrational expectations, and repulsion of personal responsibility, remains.

Some good news: The facilities of talent exist to surgically construct a functional system. One that pulls government out of the management and delivery process while moving oversight of the system to a cabinet level position and restores market-sensibilities and duties back to the delivery-infrastructure. We’ve submitted a comprehensive plan to do just this (again). Stay tuned!  

Curtis C. Greco, Founder

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