Repeal and Replace. That was the common refrain when House Republicans actually repealed ObamaCare in their chamber a year ago. Of course, the Senate Democrats rejected the repeal. But now there is a chance- some would say even a strong chance- that ObamaCare will be declared unconstitutional by the Supreme Court before the election in November. If the high Court decides that the individual mandate, which forces individuals to purchase health insurance, is unconstitutional, and that President Obama’s signature legislation cannot go forward without that mandate, ObamaCare will stop dead in its tracks. Then what?

That’s where the Replace part comes in. Now, I won’t whine and complain about how things seem to take a long time to get done in Washington, but the replacement for ObamaCare should be on the assembly line, waiting to be packaged and sent to stores near all of us. We know the talking points that make good common sense: purchase health insurance across state lines, own our health insurance policies so they are portable, tort reform, free-market principles, etc. Of course, House Budget Chairman Paul Ryan (R-Wisconsin), the reliable person that he is, has thought through a great deal of this, and has based his conservative answer to health care reform on his Medicare reform proposal.

But, where are the details and how do we plug ObamaCare’s replacement into our lives if the law is declared unconstitutional?

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Welcome to Coffee and Markets, a daily podcast from The New Ledger on politics, policy and the marketplace with Francis Cianfrocca. Today we’d like to welcome first-time listeners at our new sponsor, BigGovernment.com.

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Special to Big Government from Helen Rittelmeyer, The Daily Caller:

Capitol Police arrested ten people on the second floor of the Cannon House Office Building at a sit-in this afternoon.  The demonstrators had crowded into the office of Speaker Nancy Pelosi with a print-out of the health care bill, intending to tear up the bill in protest.

“It was a mess.  There was paper all over the hallway,” said Jeanette Beam, who traveled from Georgia to join the protest.  “They took a little old lady away in plastic handcuffs.”

The arrests, which happened a little before three o’clock, prompted plenty of chatter but little surprise.  Earlier in the day, an organizer with a megaphone had explained the plan for the sit-in.  “The police know we’re coming,” he announced.  “No one has to get arrested if they don’t want to.”

The protesters were part of a crowd of 10,000 that gathered on Capitol Hill to protest the Democratic health care bill.  The “emergency house call” was initiated by Rep. Michele Bachmann and organized by Americans for Prosperity.

Bachmann greeted the crowd from the Capitol steps: “You came.  You came to your House.”  When her remarks were interrupted by a chant of “Kill the bill,” Bachmann joked, “Oh, don’t hold back.  Tell them how you really feel!”  She continued, “Kill the bill – that’s exactly what you’re going to tell them.”

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Republican leadership, at all levels, should have learned a quick lesson about the mood of America’s conservatives from the Dede Scozzafava debacle in upper New York state. Unfortunately, the GOP House Leadership might need some remedial instruction. And a group of conservative Republican lawmakers met Tuesday to draft that lesson plan.

Michele Bachmann (R-MN) has been one of the more vocal opponents of ObamaCare. Last week on Sean Hannity’s television program, Ms. Bachmann announced the “House Call on Congress.” She urged Americans to come to Washington, DC, to a press conference on the Capitol steps at Noon on Thursday, November 5.  After the presser, Ms. Bachmann will lead the citizens through House office buildings to confront Democrats on their own turf. She hopes to draw thousands to DC to tell the Democrats to their faces, “We don’t want a government takeover of our healthcare.” Yesterday, Ms. Bachmann announced that conservative talk radio host Mark Levin would join her.

Leaders, though, tend to be cautious.  Before the Hill brass swooped in to “help” organizers by providing speaker lists and talking points, a band of conservatives formed a steering committee to keep the message and the tactics authentically conservative. These rebels don’t want talking points; they want a battle cry.

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Twenty-nine years ago I stood with my 150 classmates in Thorn Hall, at Northwestern University Medical School in Chicago, as Dean James Eckenhoff asked us to raise our right hands and repeat after him:    

I will apply measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.  In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice.

Those words, from The Hippocratic Oath written in 400 B.C., changed my life and the lives of the thousands of patients my classmates and I have touched over the past twenty-nine years. 

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CBO DIRECTOR DOUGLAS ELMENDORF: “Our Judgment Is That That Piece Of The Legislation Would Raise Insurance Premiums.” (Finance Committee, U.S. Senate, Hearing, 9/22/09)

3 Reasons Premiums Will Increase

New Government Regulations: “[P]remiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market…” (CBO Director Douglas Elmendorf, Letter To Sen. Baucus, P. 6, 9/22/09)

 New Taxes On Medical Devices, Prescription Drugs And Clinical Labs: “Those projected premium amounts include the effect of the fees that would be imposed under the proposal on manufacturers and importers of brand name drugs and medical devices, on health insurance providers, and on clinical laboratories. Those fees would increase costs for the affected firms, which would be passed on to purchasers and ultimately would raise insurance fees by a corresponding amount.” (Doug Elmendorf, “CBO’s Analysis Of Premiums Under The Chairman’s Mark Of The America’s Healthy Future Act,” CBO Blog, 9/23/09)

New Taxes On High Cost Insurance Plans: “The imposition of the excise tax on insurers can be expected to lead health insurance providers and consumers to take measures to minimize their burden from the tax. As insurers pass along the cost to the consumer by increasing price, the cost of employer provided insurance will increase.” (“Memorandum: Revenue Estimate,” Joint Committee on Taxation, 9/29/09)

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Yesterday, Speaker Nancy Pelosi and other House Democrats unveiled H.R. 3962, their latest version of the health care legislation that’s been hotly debated for months in Congress and across the country. (Read it here.) 

One thing is clear. Your concerns about a government takeover of health care have been totally ignored by Speaker Pelosi and her allies, who worked behind closed doors to write this bill. After months of debate, the bill they introduced today is essentially the same bill the American people have already flat-out rejected. 

Government-run insurance? Still in the bill. Higher taxes? You betcha. An individual mandate that restricts choices and innovation by requiring Washington to define what qualifies as health insurance? Check. A job-killing employer mandate, a budget-busting expansion of the Medicaid entitlement, and countless provisions that set Washington bureaucrats firmly between you and your doctor? Better believe it.

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[Editor: Big Government's news partner, Washington News Observer, caught up yesterday with GOP Leader John Boehner. We welcome WNO to the Big Government team and look forward to future news reports and interviews.]

In part I of this article, I provided a little background on the history of the public option, including how John Edwards was actually the first to propose it during the Democratic primary campaign. I also demonstrated how the media has largely ignored the glaring inconsistencies between Edwards’ characterization of the public option during the campaign, and how Obama has promoted it to the public this year. Edwards quite openly acknowledged that a public option could result in the entire health system gravitating towards a government-run, single payer system. Obama, on the other hand, has flatly denied this is the case saying it’s all about “choice and competition”.

I also singled out Julie Rovner from NPR as an example of a media health policy expert who has failed to fully (and fairly) report on the public option. Including the fact that many of its original (and current) proponents believe it could ultimately lead to a single payer system. Instead, Rovner has been a consistent voice of support for the Administration’s assertion that this is only a “myth”. I asked Rovner to comment on this prior to publishing part I. Here is the relevant excerpt from her response (emphasis mine):

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Most casual followers of politics did not pick up on the debate over healthcare reform until some time this past summer. They mostly ignored the umpteen news conferences held by the President since the spring, but they couldn’t miss the broader media coverage of town hall outrage. But for a small number of media experts on health policy, and an only slightly larger number of interested followers, the healthcare debate actually began much earlier. In fact, even prior to this year, when the initial policy formulation and political posturing took place during the Democratic primary campaign.

All three leading Democratic candidates for President – Obama, Clinton, and yes, John Edwards – proposed virtually identical plans for healthcare reform. The only real substantive difference being that the Clinton and Edwards plans included an individual mandate for insurance, whereas Obama’s plan did not. (Obama has since come around to supporting this mandate.) But importantly, all the Democratic plans included the creation of a government-run insurance plan to compete with private insurers. What is now called, the “public option”.

Although he was destined to be a marginal candidate, Edwards played an important role in the healthcare debate. He was the first candidate to announce the details of his plan, and really put down a marker for liberal ambition on this issue leading into the election. Especially with the inclusion of the public option. And ultimately the other candidates largely followed his blueprint, even if they failed to credit him for his leadership on this issue.

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With Democratic support coalescing around Sen. Max Baucus’s (D-Mt.) health care reform proposal, passage of a comprehensive overhaul now appears more likely than ever.  Opponents had their summer of protests.  But, Democrats have shown a renewed sense of energy since discrediting Sarah Palin’s “death panels” and Sen. Charles Grassley’s claim that ObamaCare would “pull the plug on grandma.” Still, while those charges may have been a little overwrought, there is plenty to be concerned about with the Democratic health reform effort.

As I explain in a new Competitive Enterprise Institute paper, “A Cure Worse than the Disease: Obama Care Won’t Cut Costs, But May Cut Quality,” most of the alleged cost-cutting measures in the Baucus bill merely shift costs from the federal government onto the states or private payers, without affecting long-term health care inflation.  The only measures that could reduce the annual rate of growth in health care costs would erect government barriers between patients and their doctors, while jeopardizing long-term medical innovation.

Skeptics have made hay arguing that the so-called Sustainable Growth Rate can’t be counted on to cut $245-billion in Medicare spending. But Senate Finance Committee negotiators have designed a Medicare Commission—what the White House previously called an Independent Medicare Advisory Commission—to make similar cuts in physician and hospital payment rates in a more opaque way.

In an April New York Times interview, President Obama suggested that such a group, working outside of “normal political channels,” should guide decisions regarding that “huge driver of cost…the chronically ill and those toward the end of their lives.”  That’s not exactly a death panel roving the country to pull the plug on innocent grandmas who’ve survived past their sell-by dates, but the effects could be equally pernicious.

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The headline has changed from “health care reform” to “health insurance reform” because politicians can’t go wrong politically by firing salvos at health insurance companies.  People aren’t fond of the institutions that handle the majority of the money paid for health services even if they are happy with the care itself.   Unfortunately, calling the leading proposals in Congress insurance reform is false advertising.  The basic flaw is that insurance for medical expenses will no longer exist. 

If the Commissioner of Baseball announced “baseball reform” that included elimination of pitching, batting and fielding, we would no longer have baseball even if there was a ball and bases involved.  Similarly, the leading Congressional proposals violate key principles of insurance by prohibiting underwriting, pricing, and product design based on risk assessment.

Why does this matter?  Because the absence of a true insurance product and the lack of a private, competitive insurance market will mean that the program will not work as intended to provide improvements in affordability and availability of medical expense reimbursement. 

The essence of insurance is the transfer of risk and individual risk assessment for losses that for any given individual are unexpected and unpredictable.  As Sherlock Holmes explained to Dr. Watson in The Sign of the Four:

while the individual man is an insoluble puzzle, in the aggregate he becomes a mathematical certainty.  You can, for example, never foretell what any one man will do, but you can say with precision what an average number will be up to. Individuals vary, but percentages remain constant. 

Legislation that ignores the great detective’s words cannot rightly be called insurance.

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