If we’re going to blow up ‘Obamacare,’ let’s obliterate it

If we’re going to blow up “Obamacare,” let’s really obliterate it. None of this pussyfooting around, like Republicans attempted with the disaster that is their American Health Care Act. They tried to keep the Affordable Care Act’s most popular provisions, like forcing insurers to cover those with preexisting conditions, while eliminating the parts that (sort of) keep it running, like support for Medicaid and the individual mandate to buy health insurance.

So, the plan is destined to fail in even more spectacular fashion than did the ACA, commonly known as “Obamacare.” And, not surprisingly, pretty much everyone hates it. It’s telling that I did a Google search for “good things about Trumpcare” and came up only with results about how flawed it is.

I don’t even know why Republicans are expending the energy to rush this thing for a vote before people have a chance to fully digest its projected costs. They should douse the plan with lighter fluid, light a match and say, “What, that? Never heard of it.”

Then Republicans should design a replacement that takes into account how the health industry is changing.

There is pressure for doctors of various specialties to work together and with dietitians, physical therapists and others without “M.D.” after their name to improve patients’ health. Independent doctors are consolidating into accountablecare organizations and huge health-care chains are restructuring to share and lower costs. Hospitals are shrinking the number of beds at their facilities and investing in community clinics. Prevention is the name of the game.

So are lower costs and improved outcomes. There is broad recognition that the way to drive down costs is to pay doctors based on how patients fare, instead of simply for how many tests and procedures they complete.

Improved technology and data collection are making it easier to track how patients are faring. And doctors in medical schools are being taught to analyze their outcomes, instead of just treating patients, to ensure they’re being as effective and efficient as possible.

Ironically, Obamacare started moving doctors and insurers in this direction. There are provisions dealing with prevention, lower costs and improved outcomes, but they aren’t the focal point of the current law.

They should be. I wish there were some congressional Republicans pointing this out.

The GOP does seem to understand that despite its best intentions to lower costs (”affordable” was in the act’s name, after all), Obamacare has largely become a mechanism to extend health insurance to the poor. That’s its fatal flaw. Subsidies to afford plans were doled out based on income, pricing many middle-class families out of the health-care exchange. Insurers haven’t attracted enough healthier, wealthier people to pencil out the mandated levels of coverage. So the exchanges are bleeding red ink, while those on employer-provided plans largely saw their premiums go up and their benefits go down.

I’d love to see a new system that emphasizes lower costs for all, without so much government meddling into how care providers find it. (This is one case where the ends are more important than the means.) But I’m not holding my breath. Obamacare created an expectation that health care is a right, and that government plays a fundamental role in providing it. But it failed to deliver on that promise for millions of Americans.

That’s why so many people resent the law and paradoxically, why it’ll be nearly impossible to ever fully repeal it.