Last week, we looked at some (but only some) of the problems associated with the Patient Protection and Affordable Care Act, widely known as “Obamacare.”

Republicans in the House voted against it this week, joined by five Democrats worried about their own re-election chances. Sure, the Democratic-controlled Senate won’t discuss it, but that could change come January, depending on what happens on Nov. 6.

Meanwhile, voices on the left cry out, “The GOP keeps saying they want to ‘repeal and replace’ the law, but they’re vague about the second half of that slogan.”

It’s true that Mitt Romney has said that repeal is the first priority, with a replacement created by a process Obamacare didn’t get — that is, wide debate and the opportunity for a consensus to form about what kind of health care policy would actually benefit the nation.

(Recall that then-Speaker Nancy Pelosi’s response to questions about the ACA was the now-infamous retort, “You’ll have to pass it to see what’s in it.” Romney wisely wants to avoid such arrogance and the huge mistakes such an attitude inevitably produced.)

The GOP, however, has no shortage of potential options for producing a health care system that is aimed at empowering individuals and treating them as responsible adults capable of making intelligent choices — instead of treating them as infantilized wards of the state within a system based on mandated rationing of care.

Such is the aim and result of Obamacare’s 2,700 pages of regulations, including 150 new boards, commissions and panels and at least 20 new taxes or increases in current ones.

On the other hand, it also is clear that the GOP wasted valuable years thinking that the nation’s mostly employer-based system of funding health insurance for those under age 65 was sustainable indefinitely, when it most certainly wasn’t.

What could be done instead?

One recent comprehensive set of suggestions from knowledgeable conservatives is contained in an article in the spring issue of National Affairs by health care specialists James C. Capretta of the Ethics and Public Policy Center and Robert E. Moffit of the Heritage Foundation.

The article ( /publications/detail/how-to-replace-Obamacare) is lengthy, but its principal points are these:

* U.S. health care is innovative and effective, but it is extremely expensive, because individual bills generally are paid by third parties — either businesses or the state — and almost no recipient has any motive to find economies. So “medical inflation” skyrockets, with government trying and failing to restrain costs via heavy-handed regulations in place of efficient market forces.

* Genuine reform would mean that “American taxpayers would get a break for health coverage as individuals, irrespective of their employment status or the generosity of the health plan provided by their employers.”

* The “second pillar of reform should be personal responsibility and continuous-coverage protection” in which tax-favored employer coverage still could be offered, but people would have an option to take a personal tax credit instead.

They could choose freely among policies offering different levels of coverage. People could keep the money they save by selecting the policies that best suited them, but those with pre-existing conditions could not be rejected for coverage.

If some chose not to pay extra to be insured, they could be assigned to coverage plans at costs guaranteed not to exceed the tax credit for which they were eligible. Rejecting such coverage would be possible, but no additional money would accrue and people potentially could be liable for some or all of the cost of their care, providing a powerful incentive to participate.

* Truly sick people could be placed in state-supported “high-risk pools” or some other form of collective provision, but all levels of coverage would be offered in partnership with the states, allowing different patterns of insurance based on local or regional conditions, not on cookie-cutter mandates from Washington.

* Medicaid would be transformed into block grants to the states to support insurance coverage for the poor, and states could supplement those premiums from their own resources.

* Medicare would continue for current retirees and those 55 and older. For younger Americans, the system described above would apply.

* Finally, new costs would be offset with spending cuts, with “tens of billions” available from money now spent on coverage for the indigent, who would be included in the new system.

* The goal would be to make all Americans “active, cost-conscious consumers looking for value in the health-care marketplace.

This shift would, in turn, create tremendous incentives for those delivering medical services to find better and less expensive ways of caring for patients and keeping them well.”

No doubt, these ideas can be criticized and improved, but they offer a starting point for a real discussion of systemic reform — a discussion we were not allowed to have when Obamacare was rammed through Congress.

M.D. Harmon, a retired journalist and military officer, is a free-lance writer. He can be contacted at: [email protected]

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