Column: Some Obamacare advice for Republicans: First do no harm

House Speaker Paul Ryan and Vice President-elect Mike Pence said this week that scrapping Obamacare is "the first order of business."

House Speaker Paul Ryan and Vice President-elect Mike Pence said this week that scrapping Obamacare is “the first order of business.”

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Madelyn Gilbreath can understand why Republican lawmakers say Obamacare isn’t working. She had to switch this month to a cheaper plan with a higher deductible after the monthly premium for her former plan doubled.

But she also knows that the Republicans won’t be doing her any favors if they repeal major provisions of Obamacare without a viable — and better — replacement for the law.

Westwood resident Gilbreath relies on her and her husband’s Social Security checks to get by. She couldn’t afford health insurance without the more than $700 in monthly subsidies provided by the Affordable Care Act.

“My healthcare is lousy as it is,” Gilbreath told me. “But I think the Republicans’ main plan is making coverage even worse or just not paying for people.”


She isn’t alone in facing an uncertain future. Republican leaders announced this week that President-elect Donald Trump will begin dismantling Obamacare through executive orders on his first day in office, Jan. 20. A broader repeal of the Affordable Care Act will reach Trump’s desk by Feb. 20, they said.

“The law is failing while we speak,” House Speaker Paul Ryan told reporters. “We need to reverse the damage that has been done.”

He added that Republicans will give the American people “access to quality, affordable health coverage … more choices, more control, more freedom.”

File that under wishful thinking.


Obamacare is far from perfect, but it has extended health coverage to more than 20 million of the 50 million people lacking insurance before the law was enacted in 2010. It also has ended the gruesome practices of insurers denying coverage to people with preexisting medical conditions and limiting how much will be paid if a policyholder gets sick.

Ryan promised “bold action” to make things better, but he and other Republican lawmakers can’t be more specific about their plans because they don’t know themselves. All they’re saying now is that they’ll take apart Obamacare in bits and pieces, and they’ll come up with a replacement in perhaps a few years.

The insurance industry and most major medical groups say this is crazy. They’ve warned that all this uncertainty will destabilize insurance markets and will push many insurers to stop selling coverage to individuals, putting lives at risk.

The Affordable Care Act “is a carefully woven fabric, with requirements spanning all stakeholders in the healthcare delivery system, and it provides essential protections for the health and financial stability of patients with chronic conditions,” Shereen Arent, chief advocacy officer of the American Diabetes Assn., said in a letter to congressional leaders last month.


“Congress should not risk critical advancements made under the ACA without simultaneously enacting a replacement plan that maintains or improves existing access to comprehensive, affordable healthcare coverage.”

Gilbreath, 64, said she cried the night of the election, primarily because of how Republican control of the government could affect her family. Her adult son lives at home and, as a dependent, is included on her Covered California policy. Her husband is covered by Medicare.

“I just need to make it one more year and then I’m eligible for Medicare,” Gilbreath said. “For my son, I’m just praying he stays healthy.”

Praying for health shouldn’t be the foundation of a modern healthcare system. But that’s where millions of uninsured Americans still find themselves.


Republicans appear to believe that all we’ve lacked is a robust marketplace where insurers, hospitals and drug companies can compete for people’s business. That, of course, is foolish.

Nearly every other developed nation has concluded that the only equitable way to provide affordable healthcare is to adopt a single-payer system — think Medicare for all — that spreads insurance risk among the entire population. It’s no coincidence that Europeans pay about half what Americans pay on average for equal if not better treatment.

Gilbreath and I became acquainted after she contacted me with a tale of woe regarding a recent tumble on the sidewalk near her home. She split her chin open and ended up at UCLA’s nearby emergency room, where she received four stitches to close the wound.

Knowing that her Anthem Blue Cross policy came with a whopping $6,000 deductible, Gilbreath assumed she’d probably get stuck with the full cost of treatment.


But when the bills arrived, she discovered that UCLA wanted nearly $775 for her stepping inside the ER and receiving a shot of local anesthesia for the stitching. The doctor who performed the needlework — just four stitches, remember — wanted an additional $853, of which Anthem covered about $135.

To be sure, any visit to an emergency room will be the priciest form of medical treatment available. But there’s no rational scenario that explains a $1,600 bill for four stitches.

Tami Dennis, a UCLA Health spokeswoman, said the hospital’s charges “reflect the overhead, infrastructure and staffing required” for top-quality care.

Be that as it may, Gilbreath’s experience belies Republican claims that all we need for cheaper, better healthcare are a few market reforms, such as allowing insurance companies to sell policies across state lines, or making it more difficult to sue doctors and hospitals for malpractice.


The only way to prevent for-profit companies from exploiting people’s medical misfortune, as our economic peers abroad have found, is to create the broadest possible risk pools for insurance and to impose strict rules on hospitals and drug companies to avoid price gouging.

Republican lawmakers are about to get a crash course in healthcare economics, and they’re going to find that this is a unique service with unique market characteristics. There isn’t true competition, actual costs are well-hidden and patients often don’t have the luxury of shopping around.

Obamacare got us part way to an improved system but nowhere close to the finish line (spoiler alert: Medicare-for-all is the only sensible solution).

Republicans, after years of griping about the law’s shortcomings, are now in a position to enact their own vision for an ideal healthcare system.


Here’s a little advice: First do no harm.

David Lazarus’ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to