Here we go again.  It looks like the GOP is ready to throw a bunch of monkey wrenches into the Obamacare (PPACA, Patient Protection and Affordable Care Act) system.

First, The Donald is threatening to withhold payments to the insurance companies unless America is dumb enough to use our precious funds to build the wall he wants.  You know, the one he swore Mexico would pay for.  (I have a few bridges I’d like to sell you if you believe Mexico will ante up. I’d love to augment my bank balances.)

Then, the Freedom Caucus has its own idea how it can terminate Obamacare.  You know, the promise they’ve been making for some 8 years now.

Of course, you know my preference- a single payer solution.  We all pay the government (or its designated manager) for health insurance and that’s it.

And, don’t think for one moment that it’s just those on the left that think this idea is grand.  James Capretta of the American Enterprise Institute (a conservative think tank) proposed just the other day that the US set up a system that would cover every single American.

(Part of the reason folks like Capretta have come up with such concepts is that both The Donald and Mike Pence have routinely stated that they will let insurance companies sell their wares across state lines.  Which, not only violates the principle of States’ Rights that the GOP officially holds dear (only when it suits their purposes, of course), but neglects the fact that each of the states have different (and, often onerous) conditions for providing insurance within their state borders.

Moreover,the McCarran-Ferguson Act, which became law in 1945 stipulated that the states are the primary regulators of insurance.  And, Congress passed that Act (even though it was the practice since 1868), because a Supreme Court ruling questioned the antitrust exemption for insurance and the state regulation of same.  So, Congress passed the Act.)

Capretta recognizes that most American get their insurance from employers- although that number is decreasing by the day, while the employee cost is skyrocketing by the hour.  So, the real question is how to cover folks who don’t rate getting employer-provided insurance or government coverage (Medicare for seniors, Medicaid for the poor).

His idea?  Enroll Americans in a no-premium, no-obligation plan.  WTF, you say?   Hold on, pay attention, because it’s a pretty creative idea.

He proposes that Congress require insurance firms to provide products with premiums that are equal to the Federal Tax Credits that exist under Obamacare.  So, given that the basic federal tax credit for 40-year-old fellow living in Virginia is $ 3K,then the insurance companies operating in Virginia would make a policy available for $ 3K a year to those 40 year olds.  (The rates would be different for different ages and states.)

The deductibles for these plans would also be $ 3000 (or whatever the premium actually is, after state and age adjustments).  In essence, the only thing this plan would cover is expensive medical claims- and a standard, annual physical.  (Plus, provide one “membership” in the health buyers club, that provides lower, negotiated rates for drugs, practitioners, and facilities.) And, the state would randomly assign each person (or persons within a family) to one of several plans that operate in the state.

Capretta knows that the GOP feels this infringes on one’s personal liberty.  (You know- the right to not have insurance, so when you get sick, the rest of us get saddled with your unpaid bills.)  But, the taxpayer could opt not to use the plan- or buy a much better plan.  And, the state would also require the individual to prove insurance when their income taxes are paid or to obtain (and maintain) their driving privileges.

Obviously, this is getting pretty close to the system that currently works in dialysis.  Folks on dialysis get to choose their treatment center (to a large degree), the centers bill the chosen intermediaries (who process the paperwork for the Feds), and Medicare pays the bill.

(OK.  Medicare pays the set fees agreed to for each dialysis treatment, which is somewhat different in each region of the US.  Unless the patient has not been on dialysis for 18 months yet- then their insurance company picks up the tab- a much higher one, I might add, until the patient is eligible for Medicaid.)

There’s yet another wrinkle to all these claims of erasing Obamacare.  One that sounds pretty critical- but since we rarely pay attention to the rules and regulations of the United Nations (UN), it will just be bad publicity for The Donald and the US.  (It will also increase the rantings and ravings of the far right that proclaims that the UN is trying to run America.)

You see, the UN has recently notified (2 February 2017) The Donald  that repealing PPACA without providing a substitute for the 24 million about to be disenfranchised of their health benefits is a violation of many international conventions into which we’ve entered.   Yup!  “Health care is a right” is not just the opinion of the Democratic Party- it turns out it really is a universal right.

The Office of the High Commissioner for Human Rights (OHCHR) of the UN requested The Donald share this letter with the majority and minority leadership of the Senate and the House.  The goal was to alert the public of “the potential implications of the above-mentioned allegations”.

Not surprisingly, The Donald didn’t.  Nor did he tweet that he received any such warning.

The document will become publicly available in June.  (Of course, you can read the letter if you click on my link found 3 paragraphs up right now.)

Now, you might wonder why the US wasn’t violating the law (to wit, Article 25 of the Universal Declaration of Human Rights) before we passed Obamacare?  (You’re not?  I certainly have been!) The logic (sic) is that once the right is acknowledged, rescinding it is not permissible.

Of course, the value of this letter matches the proverbial New York City joke I learned some 6 decades ago.  That the letter- plus a dime- will get you a ride on the subway.  (Yes, it means that the document only has public relations value- because the UN won’t be hauling The Donald to court any time soon.  Nor would it necessarily win.  Except that in 1994, the US ratified Article  5(e) of the International Convention on the Elimination of All Forms of Racial Discrimination.  That stipulated that the US shall guarantee its citizenry “the rights to public health, medical care, social security and social services” without regard to race or color.)

Ooh!  This is getting good!