CHARLESTON, W.Va. -- "Repeal and replace!" That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.
Since 2007, the Democrats have had to override Republican Senatorial filibusters 36O times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.
Let's assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.
Will Rogers once stated: "I do not belong to any organized political party, I am a Democrat." But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.
What should most concern my party's leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.
On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.
No, our current proposals fall flat politically and technically. But, do not despair, fellow Republicans. There is a solution that will get enough votes to repeal and replace: Medicare for All, with built-in cost controls. That is a way out, say my GOP friends. Not so.
Obama stole a well-established Republican idea from the 1990s to come up with Obamacare (the Affordable Care Act), which is really just Romneycare recycled. We can do the same to the Democrats by adopting their program, Universal Medicare.
Forget promoting the "free market, more competition" model. It clearly does not work in health care for a variety of reasons, including lack of comparative data and the way health care decisions are made by third parties, including the very concept of insurance.
A study recently looked at our health system versus other developed nations. One key finding is that our prices are out of control, causing our per capita costs to be far greater than elsewhere. The best way to control prices is a single-payer system, like they have in Canada and much of Europe.
Financing Universal Medicare is more straightforward than under the ACA. It can be done through payroll taxes, as Medicare and Social Security are now, with the burden split between workers and employers. There would be no insurance premiums, so the additional expense would be minimal. Plus, Medicare administrative costs are 3 percent , rather than 30 percent for the private insurers. More on Medicare for All can be found at the web site of the highly respected advocacy group Physicians for A National Healthcare Program, pnhp.org.
The Republican path to majority party status is clear. We just have to think out of the box and act decisively.
Bernard is a retired senior executive, formerly with for-profit health-care firms, who has worked on planning and cost containment issues with several hospitals in West Virginia. He is currently a small business mentor and a Republican County Commissioner in Jasper County, Ga.