Republicans all say they will get rid of Obamacare and give us something better. But there is no conceivable way to maintain the private insurance system and cover as many people at lower costs than the original Affordable Care Act, before Congress and the federal courts meddled with the complex interlocking system.
Right now, Obamacare has some problems that are fixable. The big one is that major insurance companies are beginning to opt out because they're losing money, and the ones that are staying are raising the costs -- sometimes a lot. Without going into details, this is the result of removing some of the incentives to get healthy, young people to buy policies -- meaning that insurance companies are left with sicker people who use more insurance, without the offset of premiums from healthier people who use it less. That's the whole idea of insurance -- spreading around the risk.
A letter to the New York Times from dermatologist Elizabeth Rosenthal last week put this very well:
"How many times must it be demonstrated that health care cannot be treated like any other market commodity before our legislators get the point? . . .I would add that a non-commercial health care system could also eliminate all the money spent on television ads for the latest designer medications. Big Pharma spends more on advertising than they do on research.
"One cannot make a profit insuring sick people. Therefore, health insurance companies are most profitable when they avoid sick people while continuing to collect premiums from healthy customers. When this does not work, raising prices is necessary to keep profits up.
"But health insurance premiums are already unaffordable for most of us. . . . The only way to make health care affordable is to have everyone paying into the pot in proportion to their income while eliminating the unnecessary expensive middlemen: health insurance companies. . . ."
Yes, Obamacare can be made to work. It's already proven that it could if given a good chance. But even at best there will be limitations. If Hillary Clinton gets the landslide win that might just be possible, maybe she will get her second chance to do what she and Barack Obama and Bernie Sanders all really would like to do: transform our entire health care system to one that is essentially Medicare for All or a similar system that provides it for all, and is paid for by all, through taxes.
A lot of lobbyists will continue to get very rich fighting such a plan, because it will eliminate or greatly reduce the medical insurance and pharmaceutical industries. Fundamental to this change will be accepting the idea that health care for all is the responsibility of us all -- and not a swill trough for the insurers and Big Pharma.