Proper Governance of Replacing Obamacare and Education Reform

 
Governments of the modern age exist to serve their Peoples.  It is, therefore, the responsibility of government to protect citizens from threats to their lives, health, and overall wellbeing.  It is also the responsible of government to provide for the general welfare of the People by ensuring individuals can provide for their own needs.  Defining proper governance with limits on government is, however, essential in order to prevent government overreach and oppression.  Education and healthcare are two critical areas where Americans struggle to define proper governance, which means they provide two excellent opportunities to discuss critical elements of proper governance.
 
This writer has argued for a shift away from  the “lifetime learning” model, which feeds an explosion of unsustainable academic spending and infrastructure, to a skill-building educational philosophy  rooted in “learning to learning,” but the question of whether government should pay for alternatives to public schools, i.e. charter schools, still remains a major focal point of reform debates.   While there are many who believe in privatization for the sake of privatization, there should be a compelling reason for government to privatize one of its function; otherwise, privatization becomes an excuse to ensure government remains dysfunctional.  If the private industry can do it better, the government should be able to do it better as well. ​

Looking at education, there is no fundamental reason public schools cannot do better, especially when it comes to primary education.  Education is not, after all, an industry where intellectual property concerns exist and a shortage of technical knowledge necessitates a reliance on private industry.  That said, government should defer to the authority of parents and parents should have a choice in the education of their children.  Consequently, government has no right to deny or impede access to private schools that, at minimum, embrace the same standards as public schools.  It is, however, not the responsibility of government to simply tax Americans to pay for what people want.  The responsibility of government is the general welfare of the American People; therefore, government should pay to reform public schools, not pay for private schools. 
 
Furthermore, ensuring access to affordable and effective healthcare is a responsibility of government, because it the responsibility of government to provide for the general welfare of the People.  After more than fifty years of fierce opposition to any reform, the Affordable Care Act, commonly known as Obamacare, took aim at the health insurance industry and forced some pivotal changes.  Under the Trump Administration and a Republican-controlled Congress, the GOP is on the verge of repealing Obamacare, yet it has failed to even restart the debate on a financially sound and politically viable replacement.  Consequently, Republicans are poised to upset the health insurance industry with a massive injection of uncertainty, which is certain to upset the broader healthcare sector and imperil the healthcare of millions.
 
In other words, the US government is on the verge of causing the American People problems instead of solving them.  The plain truth is that Americans are unsatisfied with Obamacare and the Affordable Care Act has needed revisions since it was adopted.  Under traditional political thinking, the fact that healthcare reform was passed with faults should have worked as an incentive for Republicans to reach out to Democrats, so further reforms could be made reality.  Obviously, the dysfunction of extreme polarization and zero-sum politics prevented any compromises or meaningful debate.  As such, there is a need to go back to the debate process, which has been thoroughly toxic, before repealing or even replacing Obamacare. This starts with the role of government in the healthcare industry.

​Ironically, the most caustic and vocal attacks against Obamacare have come from protesters benefiting from the socialist elements of America’s capitalist-socialist hybrid healthcare system as nearly fifty percent of the healthcare system is government controlled thanks to programs like Medicare, Medicaid, and SChip.  It is likely these critics, who want government to stay out of their healthcare, actually mean to communicate that they are against government dictating how medicine is practiced, a government takeover amounting to a fully socialized healthcare system, entitlements, which will further weigh down the National Deficit, shifting costs onto people who cannot afford it, and the possibility of diminished care. 

Recognizing the so-called individual mandate is likely the most disconcerting aspects of Obamacare, replace and repeal, versus repeal and maybe replace, should focus on eliminating the individual mandate.  The individual mandate was originally proposed by Republicans as part of a compromise rejected by Democrats in the 1990's and initially dismissed by then-candidate Obama during the 2008 Presidential Election, yet only Obamacare proponents are now keeping it alive. The individual mandate may have been central to the economic justification for other provisions, most notably banning the use of the preexisting condition exclusion, but its true role in reform was as a bargaining chip to disarm the insurance lobby.   
 
Consequently, healthcare reform should focus on replacing the individual mandate in order to ensure the sustainable of the healthcare industry and help drive down costs. Affordability is a consequence of supply versus demand that can only be alleviated by decreased demand for services, i.e. cut people off, or increased supply and better utilization of medical resources. Private or public insurance has nothing to do with it.  From doctors to bandages, the costs of treating even a healthy person mount very quickly. How resources are utilized can be drastically improved through innovation as well as better management of care. There are areas where private firms can do this better and others were the public sector has the muscle to force change.
 
What creates costs in any given private sector of the economy is the need for profits. What further adds extra costs are layers of for-profit bureaucracy.  Administrating healthcare and fees for service adds costs that can only be justified when enough savings are realized to more than pay for the service and the overall healthcare system is improved. In today's system, healthcare insurance providers add costs by exacting enormous profits while cutting benefits for those with purported preconditions. This is not improved efficiency under any definition of the term. Health insurance exists to pull reserves of capital together, coordinate care, and allocate funds in a more efficient matter.   Anything outside of these functions leads to waste as well as unnecessary denial of care, a.k.a. healthcare rationing for the sake of profits.
 
Profit drives innovation and expansion when it attracts investments in terms of financial assets, human capital, and the pursuit of novel thinking. Offering satisfactory services to patients and caregivers is one way of using profits to accomplish this goal. Building hospitals and expanding facilities with advanced technology is another. Rewarding the administrators of health insurance plans with large bonuses is not. When the for-profit insurance market solution to cut costs is increased costs to patients and employer sponsors of insurance policies with reduced benefits, their existence only adds to the inefficiency of the system. Consequently, a healthcare system driven by increased profits for bureaucrats, such as insurance providers, cannot lead to greater innovation or improved care.
 
Containing costs and paying for coverage into the future continues to be the maintain concern, yet the healthcare system must contain costs while caring for everyone in need, instead of focusing on increasing profits. Insurance companies, which will be looking to redesign for-profit schemes in an environment where coverage cannot simply be dropped or inflated, may well eventually push for a basic public option, so they can offer supplementary benefits at a profit.  Clearly, such a change will upset the insurance industry and reveal the reliance on government, but it will preserve the private for-profit and non-profit insurance market as well as access to private insurance and care.