Replacing Obamacare

Friday, July 13, 2012

James Capretta, visiting fellow at the American Enterprise Institute and fellow at the Ethics and Public Policy Center, discusses the National Affairs article he co-authored with Robert Moffit of the Heritage Foundation, called "How to Replace Obamacare."

Comments [62]

Ed from Larchmont

We needed a bill that would lower health care costs and make care available to more people (and not exempt people with pre-existing conditions). What we got was a bill that doesn't lower costs and doesn't extend insurance to everyone, but that allows government to take over the health care sector of the economy and which attacks religion and promotes the agenda of Planned Parenthood. I suspect the latter was the government's purpose all along.

Jul. 14 2012 05:58 AM
Taher from Croton on Hudson

Martin Chuzzlewit from Manhattan
The best you can do is to dismiss people
over typos. I guess thug Facists have no other
way then thuggery .
Dose this make sense-Facists?

Jul. 13 2012 10:44 PM
gary from queens

Jeanne from England from United Kingdom:
----no one defends our CURRENT system in US. And profits is what motivates doctors to work hard. I just read a testimonial from one about that who had worked in the UK.

----Sometimes i have to leave my office. I'm 60 and still have to work. Don't assume silence on my part means i have no answer.

Deborah ("We need Medicare for all, like other advanced, civilized, industrialized Western countries."):
-----They're also bankrupt. pols cannot say no to their electors. debt runs wild. learn from that.

jim from nj ("we are the goverment, ")
-----Wrong. agencies of gov had wide discretion in implementation rules, and are not accountable. liberals confuse that.

jm ("You can't have true competition without government involvement, lest we face an oligopoly or monopoly. "):
-------dumbest comment i heard. gov cannot be just another player. you watch as gov hea exchanges take over the market

g in staten island from staten island ("Health Savings Accounts are a use it or lose it account.")
------wrong. you can pass it on to your survivors

RL (You're making stuff up):
------it's a fact. most americans could be making as much as 20k more with current costs. Obamacare different. family of 4 making 40k will pay 4-5k per year on med care under obamcare tax.

Carl from LES:
-------not complicated to pick insur. general provisions sufficient. no more complicated than car purchase etc. but for those who dont care, select the default plan.

jm ("Even more ominous is the power of my insurance company to determine what constitutes acceptable coverage.")
-------with free market and competition, you are king. you decide what you want and corps must serve or go out of business. indeed, every business must make the client happy or get queezed out by those who do serve better at lower cost. every business works that way. why not healthcare?

Look to switzerland Chile. free markets. i posted on this days ago.

Jul. 13 2012 02:57 PM
Dr Steve Auerbach from New York, NY

He is very slick and seeingly rational in presentation, which just makes it all the more dangerous. But there is nothing new here. Same debunked health savings acconts and vochers, individual purchase of insurance, conservative/corporate interest to push risk to individuals and families, with guarantee of profit for insurance companies.

The real main problem in the insurance part of the system is lack of single universal risk pool. The only way to guarantee universal coverage and control both total costs and costs to individuals and families is for everybody to be paying into single "All American" insuirance pool, through the same (preferably more progressive) taxes that we pay for other universal national goods such as national security. Once you are sick and need care it is always too expensive, at the individual level. The whole point of insurance is to spread the risk. The natural risk pool is all of America: See:

What cannot work is more fragmentation and more moving of the risk to lower levels. Folsk do not need choice of private for-profit insurance schemes, they need choice and access to health care!

Jul. 13 2012 02:21 PM
Martin Chuzzlewit from Manhattan

To little TAHER-

LOL....when your GED comes through and you learn spelling and grammar, maybe we can decipher your incoherent adolescent babbling....
in the meantime, this is PUBLIC radio, not left wing radio just for people with jailhouse convert names, and I will post whenever it pleases me.

Jul. 13 2012 02:06 PM
Jeanne from England from United Kingdom

I am an American expat who has lived in the UK for the last fourteen years. When I first arrived, on the few occasions I was sick, I went to a private doctor. I wasn't going to go to some government clinic. A few years later, my husband lost his job and I was pregnant. Well I phoned up the NHS and have not looked back since. The system is not perfect but I have always been very satisfied with the care my family has received. Its goal is not about making a profit from people who are ill, it's about caring for people. Citizens here believe in the system and would never want one like the U.S. Americans are always told they have the best of everything. It is not true. And it makes me angry to hear "experts", who have probably never lived in a country which offers universal coverage, to disparage those that do.

Jul. 13 2012 12:19 PM
Taher from Croton on Hudson

RL, one last comment on that, with the way things are going and the destruction of the middle class we may end up in large-scale social disorder. When a people get disparate enough any thing can happen. And indeed these right wing shills would have remised their reasonability when the elite class, who they are suppose to protect, also gets caught in the disorder.

Jul. 13 2012 12:04 PM
james from nyc

Is it me or does he sound like he's talking out of his behind... cause it all sounds so comlicated that its garnteed to be gamed and fail...

Boy you can really see a $10 or $12 worker saying, I would sure hate to miss that $300 or $500 tax credit next april... I better pay my $1200 a month health bill this month..

I guess your guest has to do what he has to do to get paid by the super rich to do his "research" and get his employers health insurance..

Jul. 13 2012 12:01 PM

Gary, you are such a disappointment. Big talk in the beginning, but no solutions. Just complaining. What a waste.

Jul. 13 2012 12:01 PM
louie from NJ

What NONE of you have touched on is that individual health care insurance is a LOOSER for the insurance biz. Look at your backyard! In NJ where we have things like no limits on benefits, no preexistting conditions, and almost "instant" covereage, the price is STAGGERING!

And still, private insurors are staying away in droves... man up - admit that this just does NOT work.

By the way, look at the countries with single payor, gov't sponsored programs... the are going or have gone BROKE! Admit the truth.

On final point - if there was a way to money on this stuff, the greedy insurance companies would stay open "25" hours a day trying to sell it. There isn't and they are not.

Jul. 13 2012 11:55 AM

We are so immersed in the baggage of our Capitalist Society that our only measure, and first tool for evaluation is cost.and the unmitigated worship of the marketplace.We are repeatedly told that we'll achieve the best healthcare choices on the open market. Isn't that the system we've been using for the past 50 years? Aren't Capitalist Markets, particularly corporate, operating exclusively FOR PROFIT? So our hospitals, insurance companies, etc. exist in order to make profit, and often exhorbitant profit off of sick men, women, and CHILDREN! In my opinion, health care is no place for corporate profit mongering. We need Medicare for all, like other advanced, civilized, industrialized Western countries.

Jul. 13 2012 11:55 AM

If your guest doesn't want us to compare single payer in Canada to his plan or ObamaCare, how about comparing Medicare to either or the present?

Best birthday present I EVER received was on my 65th birthday. Thank you so much, LBJ and all the Democrats and Progressives who worked for so long to establish the idea of Medicare (and SocSec).

Jul. 13 2012 11:46 AM

"They have made Capitalism, with all of rapaciousness, the “be all and end all.”" - and we are a worse country because of it. sad.

Jul. 13 2012 11:46 AM

The high deductible health plans that are HSA compatible require wellcare visits before the deductible and without any cost share.

Jul. 13 2012 11:44 AM
phil from Brooklyn

The proven solution is single payer, but that said, the tax benefit disparity between employer based healthcare and individual market insurance is essentially a subsidy to Big Business in the form of a govt. subsidy for employee compensation. Additionally, it makes employees beholden to their employers for fear of losing healthcare, and makes it harder for small business without these tax-subsidized health plans to compete for skilled workers.

Both parties are up to their necks in hypocrisy with this absurd situation.

Jul. 13 2012 11:43 AM

"Home Pizza delivery is cost effective but doctor house calls aren't?"

Are you serious??? If a Dr. is just dropping off something then you might have a point. But a Dr. does not know what he will need until he examines you. Is he supposed to bring an MRI machine? What if he brings the wrong equip - law suit. You don't sue the pizza guy. Please, that is such BS that I can't even begin to respond.

Jul. 13 2012 11:43 AM
Sara from Bushwick

So for someone with a high school education who transitions from working at McDonalds to working at Walmart, how does our guest propose that they stay continuously covered?

Jul. 13 2012 11:40 AM
MichaelB from Morningside Heights

Why do we not even question how and why insurance crept in between the medical providers -- doctors, hospitals and other institutions, and the cared-for the population, the consumers?

We don't have this go-between for most other services. Why do we have it for medical care?

Jul. 13 2012 11:39 AM
James Gelineau from Princeton

What about the people who have NOT been on a health care plan because they can simply not afford it. How will HIS proposal accommodate that group without bankrupting that family.

Jul. 13 2012 11:39 AM

Why does the Affordable Care Act -- which hasn't even fully kicked in -- need to be repealed first before it can be replaced or improved -- which would throw millions into chaos? And does this person really think that his plan would be enacted exactly as he envisions it? Where was he during the months where the ACA was hammered out. Does he think the special interests -- insurance and pharmaceutical companies, AMA, hospitals, etc -- won't lobby furiously to change things to their advantage. No law will pass in some pristine state -- that's a fantasy.

Jul. 13 2012 11:39 AM

It is fatuous to discuss preserving the present private health-insurance system, because it will never reduce costs while giving coverage to everyone.

Jul. 13 2012 11:38 AM
Taher from Croton on Hudson

RL, right reactionaries have conducted, in the past 30 years, a large-scale social experiment on this country. They have made Capitalism, with all of rapaciousness, the “be all and end all.”

Jul. 13 2012 11:38 AM
Kate from Washington Heights

Why is "near-universal" care acceptable? Only truly universal care is decent in a wealthy society - in any society, but especially when there are vampire capitalists like Romney around.

Jul. 13 2012 11:37 AM
Amy from Manhattan'

What if people lose their insurance rather than voluntarily dropping it?

Jul. 13 2012 11:37 AM
REM from Albany

You call this guest conservative? Well, I call myself progressive and in general, I call this conversation sensible. Thank you for inviting a guest who actually talks about HOW we might begin to bring down the astronomical costs of healthcare. Aside from the poisonous use of the word "repeal" which hits me hard - as I imagine "amend" or "Obamacare 2.0" might hit conservatives - there seems to be room in this discussion for civility and compromise which could get America to a better wellness system.

Jul. 13 2012 11:34 AM


Home Pizza delivery is cost effective but doctor house calls aren't? I say, less pizza and more house calls :)

Jul. 13 2012 11:34 AM
jim from nj

Gary, you write
"And government is the sole entity in our lives which has the authority to compel us to do things".
My conscience compels me sir, to point out that we are the goverment, that what the the last 230 odd years have been about.
Good luck with the unpublished article.

Jul. 13 2012 11:32 AM
thatgirl from manhattan

brian--don't misinform by saying the ACA isn't "portable" insurance, because ones coverage purchased via the proposed exchanges IS portable--it exists whether one has employer-based coverage or not. it's not like if an individual who purchases coverage via the exchange loses it should they change jobs and have insurance made available to them via an employer; they may choose to elect employer-based coverage if offered it, but they don't have to give up their independently-purchased insurance.

Jul. 13 2012 11:30 AM

"I am old enough to remember how..." You're old enough to remember a time with conservatives did not make Capitalism the be all and end all. House calls are not cost effective, so they ended long ago along with other things that we did because they were the right thing to do. Dr. Gitlin would hate the fiscal world that conservatives have created.

Jul. 13 2012 11:27 AM

LOL at "charity based hospital system." Sure, great idea!

Richard is correct about the inverse cost/care formula provided by other countries with single payer, in comparison with the US system.

Can you imagine if small businesses could hire employees based on desirability as opposed to who can "afford" to work for a place without the benefit advantages of a large corporation?

Establish a single payer system, supplemented by optional additional private insurance. If you want to encourage free-market competition among insurers, watch as they scramble to capture a consumer who doesn't have to rely upon them (as with home and life insurance).

Even the most cynical, wallet-clutchingest Republican or Libertarian would have to admit we need a healthy crop of young Americans for military service. It's part of the country's infrastructure.

You can't have true competition without government involvement, lest we face an oligopoly or monopoly.

Jul. 13 2012 11:27 AM
m katzenelson from NJ

A public option is the only solution that works.

Consider average lifespan is the bottom line measure of a nation's health car.

The US is number 38

The top of the list are all nations with socialized medicine.


An other answer has to ignore the facts.

Jul. 13 2012 11:25 AM
g in staten island from staten island

1)Health Savings Accounts are a use it or lose it account. You have to do contortions to figure out how much you need/will use each year.

2) A lot of people have health insurance that pays "80% of reasonable and customary charges". If your office visit or procedure costs more than "reasonable and customary" you pay 100% of that additional charge--above your deductible. People are cost conscious!

Jul. 13 2012 11:24 AM

Taxing health benefits is a tax increase that will affect lower and middle class workers and make no difference to higher paid workers. This is similar to the GOP's calls to "widen the tax base" instead of slightly increasing taxes for the wealthiest Americans.

Jul. 13 2012 11:24 AM
Tim from NJ

If young people are given a ‘money’ to buy health care, what prevents them from taking the money and running because they don’t think they need coverage. Again you reduce the size of the pool and it becomes more expensive .

Jul. 13 2012 11:24 AM
Taher from Croton on Hudson

Martin Chuzzlewit from Manhattan , if you hate this radio show so much why not listen to RIGHT WING radio man. There is much you would agree with. And no heart attacks. Just hate.

Jul. 13 2012 11:23 AM
gary from queens

Guest made a good point about obtaining low cost preventive coverage. But even without that, with third party coverage with no price competition pressure from the purchaser, you get no incentive for lowering of costs.

I had no dental coverage for 25 yrs. I knew the price of filling cavities. During those years, I brushed and flossed like a MotherF--ker! Why? because I knew the consequence of not taking care of my teeth

Jul. 13 2012 11:22 AM
Jon Pope from Ridge, NY

gary from queens, You'll never win anyone over by calling them "dummies". How about trying to make your point without insulting anyone who does not agree with your "opinion"?

Jul. 13 2012 11:22 AM

"Health savings account very successful in some states" - only for people who know better and that's a small part of the US.

"People with health benefits are actually paying $20K per year for that, in leu of wages..." - If you believe it's in leu of anything, I got a bridge to sell you.

You're making stuff up. Next!

Jul. 13 2012 11:22 AM
Taher from Croton on Hudson

Vouchers? Good way to kill all affordable health coverage. Only the very rich get to have health medical insurance and the rest have minimal vouchers to buy very transparent health plans. The voucher holder becomes active or dead. Thank you sir.

Jul. 13 2012 11:20 AM
Trish from NYC

I am on an HSA, and the high deductible healthcare plan DOES cover all wellcare for 'free'. I believe that in New York, that is a requirement.

Jul. 13 2012 11:19 AM


I am old enough to remember how the powerful doctor lobby of the time, back in the early 1960s RESISTED the creation of Medicare and MEdicaid. Many then were saying that the rich doctors want to protect their right to play golf and own yachts. But the doctors warned what was really was going to happen, and it did. We got the bloated, costly, disjointed, convoluted system that we have today. I remember when my family doctor made house calls to the HOUSING PROJECT that I lived in the the 1950s, and charged us what we could afford. He charged people what HE felt they could afford to play, God bless Dr. Gitlin wherever in heaven he may be today.

Jul. 13 2012 11:19 AM

HSAs only work for the affluent. Try again.

This guest is great at restating the "factors", but I'm not hearing any Replacements. Once again, a conservative with no answers; just more complaining.

Jul. 13 2012 11:18 AM
Carl from LES

Does this guy really think that we want to become experts in health care plans?! Health care insurance is very complicated, average people have enough issues in life to deal with.

Jul. 13 2012 11:17 AM
Sheldon from Brooklyn

Becky.... a single payer system would have been awesome.

I never understood why businesses accept the norm, of paying for their employees' health care.

Jul. 13 2012 11:17 AM

Any "solution" that preserves the present system of private health insurance is as much a pact with the devil as is the Affordable Care Act. Other countries have half the health-care costs of the US with equal or better care, through single payers. What's the mystery?

Jul. 13 2012 11:16 AM
Gary from queens

DEAR John A from WC:
An MRI at for inguinal region of leg at Open MRI on Hillside and Francis Lewis cost $500 in 2009.

Health savings account very successful in some states, and Chile. It will soon be illegal in US under Obamacare. People with health benefits are actually paying $20K per year for that, in leu of wages they would receive without the "benefit" included with their employment

Jul. 13 2012 11:15 AM
Amy from Manhattan

Does the article address the issue of insurance company abuse, from cherry-picking members to dropping their coverage when they get some expensive disease? I keep hearing right-wingers say they don't want the government getting between patients & doctors, but I'd rather have that than have insurance co's. between patients & doctors.

Jul. 13 2012 11:14 AM
Caitlin from Jersey City

What exactly defines a "low cost, high value" insurance plan? I've had individual plans and I can tell you, the lowest-cost plans are extremely LOW value.

Jul. 13 2012 11:13 AM

"...had it remained in place ..." But it didn't because capitalism pushed it out. So, wrong answer. Try again.

Jul. 13 2012 11:13 AM

I am a supporter of Obamacare who agrees that employer-based health care should NOT have been a part of the law. We all need to be able to afford health care without depending on an employer to provide it.
But this doesn't mean the entire law should be overturned.

Jul. 13 2012 11:10 AM
The Truth from Becky

Replace it with what? If ONE republican can explain that in detail, that would be great!

Jul. 13 2012 11:09 AM

The more this health coverage debate goes on, the more I am convinced that the large intervention by the government into the health care industry was a tremendous blunder.

The simpler way of a free-enterprise health system coupled with a charity hospital system, as was the case in the 1950s - had it remained in place - would have been more rational and less costly, and just as effective. Maybe more so.

Jul. 13 2012 11:09 AM

"An ominous feature when you add to government powers the control over healthcare."

Even more ominous is the power of my insurance company to determine what constitutes acceptable coverage.

That said, I'd LOVE to get the employer out of the equation!

Jul. 13 2012 11:08 AM
The Truth from Becky

Martin Chuzzlewit
Martin Chuzzlewit
The Life and Adventures of Martin Chuzzlewit is a novel by Charles Dickens, considered the last of his picaresque novels. It was originally serialized between 1843–44.

Jul. 13 2012 11:07 AM
John A from WC

Gary, out-of-pocket, a trip to the doctor costs me about $350 and to the MRI about 20 Times that much (the price I was given). To say that adding 5% to something to get a trained opinion is wrong just makes you look crazy, IMHO.

Jul. 13 2012 11:05 AM

Gary, I think that you make the point of this segment and it has not even started yet. It's called Replacing Obamacare, and you've typed more than I've ever read here without a logical alternative. You've got no answer; just hot air.

The problem is not insurance. The problem is that in the US we will not let people die in our streets. Anyone can go to an emergency room at any time. And the rest of us pay for it. But that's not fair, so how do we come up with a group answer to an individual problem?

And the free market does not work in this case, because there is no limit that we will pay to not die (or we will pay to not let our spouse or children die). Capitalism can solve many problems, but not this one. It doesn't work for everything or anything that doesn't have a supply & demand limit.

There are only 2 answers: 1) we let people who can't pay die needlessly; or 2) we address the problem as a group - that's what governments are for.

Jul. 13 2012 10:59 AM
Martin Chuzzlewit from Manhattan

The priority for America shouldn't be to "replace Obamacare" but rather to "replace Obama".

Why focus on replacing the 3,000 page bill rather than its cheerleader-in-chief who saddled us with this monstrosity and then begrudgingly admitted that he had never actually read the bill?

Hopefully, there will be a successful "impeachment" vote on Tuesday, November 6.

Jul. 13 2012 10:56 AM
Jeff Park Slope

You make excellent points but in my view, you are figuratively wasting your breath writing on this site. You bring up facts and use reasoning. These things do not seem to apply here. A few years ago it occurred to me that we have a very clear way to determine whether some people can be convinced based on evidence to change their views. Rudy Giuliani ran for Mayor 3 times. If a New Yorker chose not to vote for him by the third time he ran - after he helped to save the lives of thousands of New Yorkers by reducing the murder rate to levels thought impossible, revitalized Time Square, eliminated the squeegee men, enabled the city to function after years of chaos, etc. - if after all of these significant accomplishments people still will admit to not having voted for him that third time, then in my view, there is no hope that written evidence will convince them of anything. How many regular readers on this site do you think voted for him? They are too bound to ideology. They are not properly educated (how many regular readers of this site did not know that Martin Chuzzlewit is the title character of a Dickens novel? -they must have read no Dickens in school else they probably would have seen his list of other novels) they do not seem to understand conservative arguments (usually calling them subterfuge or saying that the speaker is trying to fool them), interpret just about everything in terms of racism and sexism and see wealth as evil except if it has been earned by celebrities. At least one person wrote that if one doesn't support Obama they shouldn't listen to the show and that if they are not of a particular race they can't write about that race. So what's the point? This is clearly my view, not yours so please feel free to ignore it or disparage it.

Jul. 13 2012 10:55 AM
Sheldon from Brooklyn

Ed - "restrain" religious groups from what exactly?

Jul. 13 2012 10:00 AM
gary from queens

There's many things about gov healthcare which conservatives don't explain, let alone explain well. Let me quote from my own article, not yet published:

The essential argument is that our health is an intimate and comprehensive part of our lives. The most personal things about us are related to our health. And government is the sole entity in our lives which has the authority to compel us to do things. Putting government in charge of healthcare increases government power over our lives in the most comprehensive of ways. The power shift towards government and away from individuals begins with dependency, then submission to demands. It begins with medical coverage, but will lead quickly to diet and lifestyle mandates––what we eat; where we live, what we drive; what we purchase; etc. It will involve loss of privacy, which is also a loss of power. It will include vaccine mandates greater than we have now. It will be the vehicle to enforce "it takes a village"––the ideology that the state is more competent to decide your affairs, and what is best for your children.

One may argue that the state already has power over us. But it's basically limited to confiscating or distributing wealth––the power to tax; grant subsidies & abatements; rezoning; licensing; etc. (We don't even have a military draft right now.) But health affects us more directly––our very lives. And Obamacare will introduce unprecedented levels of government and semi-government access to our personal finances and health records––all digitized (see appendix). Would organizations or individuals suppress their views, from fear of political retaliation that would affect their healthcare policies? Would a person be less willing to criticize an agency of government that has total and complete access to his finances and health status? Look how J. Edgar Hoover survived so many administrations. Presidents were afraid to fire him because they feared he held personal information about them. Imagine how each of us would feel about an agency or bureaucrat who held all of our personal information. Say goodby to freedom.

As Christopher Chantrill argues, government--through its bureaucracies--induces people to be either loyal to, or dependent upon, government. An ominous feature when you add to government powers the control over healthcare. What political organization----feminists, elderly, religious, unions, etc.----would dare criticize an administration whose HHS Secretary could wipe out their favored medical coverage with the stroke of a pen? Whereas if we had a medical system in which the patient was king, then doctors and insurance companies would compete to serve the public's needs. Right now they serve their own needs--wealth, control, and maintaining its monopoly advantages.

Jul. 13 2012 09:37 AM
gary from queens

The reason Obamacare won't work is explained in my article

Centralized control of prices and resources do not bring down prices and incentivises excellence. Today we have high prices via government santioned cartel among insurers (it aint insurance!), government, and allopathic medicine.

Obamacare centralizes even further rules and funding of the private care system, making it "private" in name only. The government health exchanges will mimic the DMV. It will operate the way Stella Paul describes NHS in the UK:

We need a consumer driven market to force competition among insurers. That would include high deductable catastrophic policies, which are illegal under Obamacare.

In other words, why should I pay for a policy that includes pediatric screening, free contraception, and I think, free mouthwash and deoderant. I have nothing against these minor hygienic expenses. I just think (1) I can afford them, (2) I will really afford them once insurance for them is stopped, and (3) They are not what insurance is designed for.

Dummies who favor the current system: Insuring ANYTHING increases its price 3 fold.
Dummies who favor single payer: gov price controls never worked in a free market society. It isnt even working in the UK or Cuba (just talk to Cuban immigrants!)

3 yrs ago I walked into "OPEN MRI" on Hillside Avenue in Holliswood, with cash in my pocket, to obtain an MRI image of my inguinal region, where I clinically self-diagnosed a tear in my tendon. I was told my cash was no good without an doctor's prescription. I told her I have no doctor and no insurance. She said sorry, that's the law.

The monopoly among providers and insurers to control our health will be far worse under Obamacare.

Jul. 13 2012 09:26 AM
Ed from Larchmont

The society can't afford this plan, flat out. And the purpose is not so much health care as it is to restrain religious groups: they have to pay $100 per day per employee if they don't comply, many beginning in August. They will have no choice but to close. These organizations save the government much money by doing things the government needs done, and the government can't afford to do.

Jul. 13 2012 05:52 AM

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