Republicans have indicated repealing Obama Care will be the trigger point for their universal health care program.   We have yet to get a definitive plan from any candidate to answer to the question … what is needed and what is affordable?

Therefore, instead of repeal I propose amending it for the pork and replace those improprieties with the real meat?

Pork:

1. Insurance exchanges are State run insurance agencies generating higher and higher deductibles and coinsurance. This will reduce access to services due to beneficiaries being unable to afford upfront costs.  Get rid of them.
2. Medicaid is the worst idea ever mandated due to the spend-down requirements bankrupting the patient and family only to be granted very marginal care without rehabilitating anyone.  Replace Medicaid with a revised Medicare Part C.
3. $1 trillion dollars over the next 10 years to fund demonstration projects with grants to universities and liberal think tanks to prove what Obama care has already decided.  Get rid of demonstration projects.
4. $1 trillion dollars over the next 10 years to fund 16,000 enforcement IRS agents to police and penalize those who don’t have insurance.  Get rid of enforcement provisions of Obama Care.
5. $1.2 trillion dollars hidden taxes on appliances and services considered to be contributors to chronic diseases. None of this is supported by scientific findings.  Repeal this section of Obama Care.
6. Under budgeting estimates for the cost of Obama care by not factoring in the declining health of the baby boomers who will overrun the capacity to provide services due to the lack of physicians and nurses.  Revise the payment system to a patient centered pricing system using episodic costing and pricing.
7. Young healthy Americans are flocking to Bernie Sanders and his solutions to the loading of all the cost of Obama Care at their feet … as a result they are looking for an alternative to Obama Care.  Make the amended plan attractive to the younger more healthy beneficiaries with lower front end costs.

Meat: SHIFT THE PARADIGM (self-health insurance funding trust) from socialized medicine to enterprise heath preservation based on outcome not income.

Get rid of the insurance exchanges and create a new insurance entity that is owned by its covered lives (mutual companies as we have in life insurance).

1. Get rid of Medicaid and replace it with withholding from employed Americans who have their own insurance trust accounts and are responsible for their own health and health care costs.
2. Retain Medicare for the current beneficiaries and convert all payment to episodes of care from physician to hospital to long term care using standardized cost models. The models are computerized and are used as admission estimators that holds each provider of care to a budget by episode for length of stay, labor, supplies,, medications, overhead and profit margins.
3. Rid health care system of $1 trillion dollars of costly demonstration projects that only give government more control and the $1 trillion dollars reserved for expanding the size of the bureaucracy for enforcement that hasn’t worked for 35 years and will not work now.
4. Utilize any added research to a private enterprise effort not a public sector controlled waste of valuable resources to pay for the unemployed Americans needing a safety net. This should be the new Part C of Medicare by riding the system of the current Replacement Medicare insurance plans.
5. Retain traditional Medicare Part A, B and dump Part C and D due to the fraud and abuse that CMS has imposed by their overreaching regulations killing that competitive spirit of private business.
6. With the savings from the first 5 amendments a defensible budget plan can be proposed including making the front end costs much lower to allow the younger more healthy beneficiaries to be able to afford the  plan.

What’s left of Obama Care is the platform for a truly universal health care program that is both private and public sector administered. The intent of the law is supportable but the policies and implementation procedures are purely academic leaving out the entrepreneurial spirit in its purpose and outcome.

Currently the bureaucrats and PhD’s are forming a Monopsony system that is driven by input data not output data (using negative income incentives and false ratings rather than positive outcome results) that keeps the control in their hands not the providers and producers of GDP. The results are clear when you examine the failure of the VA and America being 38^th in worldwide quality and having the highest cost per patient.

If you want to look at a similar Enterprise example go to the Singapore Model (number 1 in quality and cost per patient) … no other known health care program will make our current situation acceptable to our aging voters.