Health care is a mess. Let me tell you what I think of the Republican health reform bill by way of the following story.

It is said that Teddy Roosevelt threw a large dinner party at the White House. And after dinner he snuck away to grab a brandy and cigar in his library. There sat an attractive young woman, reading a book. The President sat down and greeted the young woman, and a long silence ensued. Finally, the young woman spoke in a low voice, "Excuse me Mr. President. We're here alone and no one can hear us. Tell me, do you find me attractive?" "Why yes,” said the President.

"So let me ask you this, Mr. President," said the woman. "Would you be willing to pay $500 dollars to have your way with me?"

"No", said the President, “but I'd be willing to pay five dollars." “What do think I am!" yelled the woman.

"We've established that,” said the President. “Now we're just haggling over price."

You see, we've established that the government is going to control the health care system in this country -- now we're just haggling over price. What happened to tort reform? What happened to buying insurance over state lines? What happened to ending all subsidies? Subsidies are increasing. The Republican bill concedes that the federal government will be in charge of health care in this country to one degree or another for as far as the eye can see. It now is being decided who gets what and who pays for it.

The American Health Care Act that is billed as a law that will “repeal and replace” Obamacare is as mistitled as the Affordable Care Act.

When I was a young man, doctors made house calls. Doctors were relatively poor, especially young doctors trying to build up a practice. So they went to the patient when they could. Today it is inconceivable to ask a doctor to make a house call.

When I decided to get health insurance at 21 years of age, I was given a contract that showed the premium and approximate price my insurance rates would rise as I grew older. They started very low and grew larger as I approached 65. I assumed that I would be making a lot more money as I aged, and I was right. Everything was predictable; enter the government.

The Great Society programs of Medicare and Medicaid voted for in 1965 were very small at that time. Only a fraction of society was on those programs. Now 40% of society is covered by those two programs. And employers have been dragged into the healthcare business over the years, insuring every one of their full-time employees.

Let’s say you have a job and your employer pays all or part of your health insurance. If you get fired, or your company goes out of business, or you are reduced to part-time work and have a pre-existing disease, you’re in serious trouble. If you get seriously ill you can conceivably lose your life savings and your home by being dropped from your health insurance. This was not the case with me over most of my life. My insurance was portable and went with me, and the deductibles and premiums stayed stable even as they increased over the years. They were never a serious burden to me.

That was a free market health care program at work. Other than Social Security, the federal government was never involved much. But as government intervention increased over the years, so did the problems associated with health care for most of society. Over time choices have dwindled, health care wait times have increased, and the quality of care has decreased in many cases. Certainly this is true at Veteran Hospitals. And many who lost their jobs as they grew older lost their insurance forever.

There is no easy way back, but my suggestion is the following: as much as I hate subsidies, why not grandfather the subsidies for pre-existing diseases into the health bill. Let all presently insured be subsidized by the government, since it is the government that caused the mess in the first place. We have to take responsibility for what we've caused. New health care recipients, however, should pay for their health plan when they are young and healthy with a lifetime contract, agreed to by both buyer and seller with clear and specific terms.

To encourage this, I suggest we eliminate free hospital care. Alert everyone that they need insurance or they will be billed for any services rendered. That's the way to get the youth to buy insurance. As the young grow older and more wealthy, insurance premiums will naturally rise and their newly acquired wealth will be vulnerable if they are hospitalized. The incentive is to buy insurance and buy it earlier rather than later. It is the fact of loss that encourages us all to have insurance.

This is the way it used to be -- and people were not "dying in the streets". If you want to see that, just go to a Veteran's Hospital where the Federal government is in full control and everything is free. Personal responsibility needs to be taught to kids at home and in schools, and they need to be taught what may happen to them if they are not insured. Young adults need to be taught that their lives can change dramatically for the worse without proper insurance.

As society ages the old will disappear from government health programs and the young will have insurance and the market will control health care instead of politicians and bureaucrats controlling it. It would be a transition from government run health care to privately controlled health care. It will take decades, but every year we'd see less government and greater private involvement in the health care industry. 

One more thing...I would like to see a fund set up privately to provide financial help to those that are in serious need of care or are born with pre-existing diseases. People give donations and sometimes will large sums of money to charities. We are the most generous nation on earth and there is no reason we can't take care of our own without the governments help.

After all, we give millions to charities saving the lives of cats and dogs; and we give millions to other nations to help people in need all over the world, most notably, children in Africa. We see slick commercials made to solicit funds from us that raise millions. They play on our concern for the needs of cats and dogs and impoverished children. And that’s fine. But what about our children? Why can't we give to our own sick and injured that find themselves in an impossible situation through no fault of their own? Surely with all the millionaires and billionaires in this country, let alone all the rest of us in America, we can handle this voluntarily.

This would give Hollywood a chance to put their money where their mouth is and contribute to the saving of lives of the sick and injured. Let Hollywood set up a fund to prevent babies from dying and save people from "dying in the streets". Call it the the “Jimmy Kimmel Fund” which should be very appealing to them. And we could ask the Clinton Foundation and the Bill Gates Fund to channel some of their huge resources to our people who are in need of health care and can’t afford it, instead of channeling it all abroad. 

And if there still is not enough money to provide adequate care, we can take some of the billions the government gives away to other nations as foreign aid and make America first in line to get help. In every case where we ask who will help those in need, I suggest we think first of charities and non-profit funds before we think of the federal government, which should be the last alternative, not the first.

These charities do not have to be national. They can be local or have local branches as the Red Cross does. And these charities do not need to pay the entire hospital bills of the needy forever. They can choose to buy insurance policies for the needy and pay the premiums for those with pre-existing conditions. This would be a fraction of the cost since the insurers would pay the lion’s share as they already do. I’m sure many funds would invest in catastrophic insurance policies as the best bang for their buck. Think about the possibilities this would open up.

Health care reform needs to occur if we are going to get back on the "right track" in this country. But it’s not a matter of just passing something. That “something” needs to work to improve the lives of Americans. And it needs to be followed up by legislation that cannot now be put into a reconciliation bill.  All those things that need to be done cannot be done at once.

It will take many years of reforming to get back to a free market where health care belongs. Sound impossible? Look at the auto insurance market. You don't see any problems there. Or the home insurance market. That's a free market. And that's the way health care insurance would look if we allowed it. 

If, however, the above is impossible, and I concede it might be, my plan “B” is to push everything back onto the states. Let there be 50 states competing for the best health care they can come up with. We will have experiments no doubt from socialized medicine to free market health care and everything in between. But we will end up seeing what works and what doesn't, and the citizens of this country can vote at the ballot box to change things, or vote with their feet.

The Republican health plan is a start in the right direction...but we've got a long way to go.

Paul Nathan