Our new state leaders, Gov. Paul LePage and Attorney General William Schneider oppose the Affordable Care Act – the federal health reform law passed with so much travail by the President Obama-led Democrats in 2009 – and have vowed to sign on to dissident state efforts to repeal it.

Still, it was a clever move by the Maine People’s Alliance to collect 2,500 hand-written post cards, most of them from small business owners and health professionals, opposing repeal of the ACA. The gesture exposes the emptiness of the Republican efforts simply to get rid of the major achievement of the Obama administration.

Republicans have no solution to the daunting problems caused by an irrational system that leaves one in six Americans uninsured, and countless more under-insured, yet also manages to spend at least 50 percent more per person than any other system in the world.

To the extent they have an answer, it is to insure only for long hospital stays and the most expensive medical procedures, while depending on consumers to shop around and demand lower prices for everything else.

If health care were like shoes or lawn tractors, this might actually work, but it is not. Few health care consumers can easily check hospital prices while understanding exactly what procedures they need, and who can best perform them.

Instead, as in every other country in the world, we depend primarily on doctors and hospitals to tell us what we need and how it will make us well. Yet there’s no system here to make these decisions, only a giant collection of third-party payers, comprising a vast array of state and federal programs and private insurers that shift costs around in circles.

The bewildering, multiple and nearly incomprehensible statements you receive for even relatively minor hospital procedures – the ones we’re supposed to pay out of pocket – are the most visible sign of the waste and inefficiency that dominate American health care.

Would the ACA solve these dilemmas? That’s far from certain, but simply returning to the status quo, as the GOP insists, would be an act of national insanity.

Republicans in state houses and Congress know they don’t have the votes to repeal the health care law now, but they’re hoping the courts may do it for them.

New York Times columnist David Brooks observes that one federal judge, appointed by George W. Bush, found the mandate to purchase health insurance or pay a fine unconstitutional, while two judges appointed by earlier presidents upheld the same provision. He then predicted the U.S. Supreme Court, with its five Republican appointees, will likely overturn the individual mandate, 5-4.

While it’s distressing to think our judicial system is that relentlessly partisan, the possibility can’t be dismissed. After the Bush v. Gore and Citizens United decisions, the former installing Bush as president and the latter overturning a century of precedent to allow corporations unlimited political contributions, it’s clear our highest court will virtually ignore legal facts to reach a conclusion it wants.

But it’s a classic case of being careful what you wish for.

The ACA’s insurance mandate presumes that if everyone is in the health care system, we will then be able to overhaul it in line with some of the pilot projects it authorizes. The most important ones establish clinical guidelines like those used at the Mayo Clinic in Minneapolis, where doctors are paid salaries and receive bonuses for healthier patients, not extra pay for ordering innumerable medical procedures.

The Mayo practices are like those of every other developed country, and are only possible through a single-payer system, or one with heavily regulated private insurers.

If the individual mandate fails, there’s no chance of rationalizing the system since millions would be uninsured, and President Obama would have little choice but to call for a nationalized system – what many of us thought he should have done in the first place. State insurance exchanges and federal subsidies aren’t going to work unless the system is nearly universal. They may not work even then, but we have to hope they will.

No epochal changes to a system that’s so important to each American, and represents 16 percent of the economy, are going to be immediately popular, so forget about the polls showing divisions. We need a system that can work, and that’s what the Republican lawsuits will sabotage.

The need doesn’t go away just because one party organizes a short-sighted political movement against one solution. Prolonging disorder in our health care system will make us weaker as a nation, and even less likely to regain our position as a world leader.


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