President Trump made some experts snicker when he explained the delay in unrolling the Republican replacement for Obamacare: “Who knew health care was so complicated?” Pundits who had spent years sweating the details of the many facets of health insurance policy came back at Trump with versions of “Er, hello? We’ve been saying that for years. Now if you’ll turn to page 723 of my proposal….” Indeed the policy details are enormously complex, and I won’t presume to wade in as an amateur to the debate over whether the current Republican proposal is the smartest or most politically viable plan for setting free one-sixth of the U.S. economy.

One thing conservatives have been right about all along: Obama’s plan was so complicated and unsustainable, it was tempting to believe that it was constructed that way on purpose. By building a Rube Goldberg machine that first entangled millions of Americans, before collapsing under its own weight (well after he’d left office), Obama would create the conditions where Americans would demand that the federal government “solve” the new healthcare crisis by creating a single-payer, British-style system of socialized medicine. In effect, the whole country would just slide onto Medicare.

Hard-working conservative policy wonks have been toiling for years to propose politically and fiscally workable alternatives to Obamacare. Most of these experts are sharply critical of the new plan Trump is backing, which seems to be a kind of Obamacare Lite, with tax incentives that slightly favor the better off, and a different kind of penalty for those who don’t buy insurance. I lack the expertise to wade into the details and try to clarify them, but the principles underlying them are clear. There’s a fundamental moral problem at the heart of the healthcare debate, which various plans — Obamacare as well as its conservative alternatives — have flailed around trying to solve.

It’s the problem that economists call the “free-rider.” I can explain it best with a personal anecdote. Last week one of my deranged rescue beagles yanked the leash so hard that it messed up my right wrist. (I’m a righty.) The pain was blinding, throbbing, debilitating. I couldn’t write my column. It hurt to use the mouse for any reason. In a perfect world, I would have gone to a hospital emergency room to get immediate care — since making the arrangements to get into an orthopedist would have taken days, during which I couldn’t work (or even brush my teeth very effectively).

Emergency Wards Full of Illegal Immigrants

Of course, since I live in the real world and my sister is a nurse, I knew better than to go anywhere near an emergency room — which are chock-full of people without any health insurance, many of them without the legal right to reside in this country, lining up to get routine care which they won’t ever have to pay for. Who would have to pay for them? I would. When insured, paying customers do turn up at the emergency room, they must be soaked to cover the costs, or else hospitals will close. The sheer number of free riders force the “fare” paid by regular customers to crippling heights — and that is why after a childbirth or short hospital stay, you will see on your bill itemized charges like $20 Q-tips.

I didn’t want to come home with a bill that socked me for the whole cost of my annual deductible for a single injury, so instead of going to the doctor, I found a massage therapist and relied on Advil and ice baths. Thankfully, I got better. But it struck me as a rather ironic that because I have a job and insurance, I have effectively less access to emergency care than illegal immigrants willing to wait several hours to get routine care from an emergency room — which typically won’t turn anyone away, even if there is little evidence of any genuine emergency. The New England Health Care Institute (PDF) warned back in 2010:

The overuse of U.S. emergency departments (EDs) is responsible for $38 billion in wasteful spending each year.

ED overuse is on the rise across all patient populations, irrespective of age or insurance coverage.

Drivers of ED overuse include lack of access to timely primary care services, referral to the ED by primary care physicians themselves, and financial and legal obligations by hospitals to treat all patients who arrive in the ED.

Turning Doctors and Nurses into Indentured Servants

The numbers are surely worse today. The combination of federal laws and liability risk makes it very difficult for staff at emergency wards to simply say “No” to someone who turns up with an ear infection or flu symptoms, and wants to be taken care of — though they are quite unable to pay, and don’t qualify for Medicaid (since they’re illegals).

Congressman Ron Paul, MD, had the right answer to resolving this free rider problem. He shocked people in the 2012 presidential campaign when he said that the government should remove any legal or regulatory requirement that doctors or hospitals treat people who won’t be able to pay them, apart from obvious, life-threatening emergencies.

Rep. Paul was right. Food is just as crucial to life as health care, but we don’t let hungry people turn up at restaurants and ditch the tab. There is no moral case for drafting health care professionals into indentured servitude for those unable to pay. The fact that emergency wards are available for this purpose surely discourages a certain percentage of people who could afford health insurance from spending the money to get it. And of course, we should not be providing free medical care — except for life-threatening emergencies — to illegal residents at all.

Americans Who Game the System

So that’s one kind of free rider. But here’s another, home grown specimen. Someone I knew, a working attorney, churchgoer and political conservative, told me that he really resented the Obamacare mandate that he sign up for health insurance. He was healthy, young, and physically active. He didn’t like being pressed into the insurance pool to effectively subsidize older, sedentary people who needed care. So far so good, I guess.

But then I asked him why he didn’t sign up for some form of catastrophic insurance. What if he got in a car accident, or was struck down with some rare cancer? He didn’t have savings or assets that could begin to cover the real costs of health care he’d need. How would he deal with the bills that would come from hospitals and surgeons?

At that he shrugged and smiled. “Oh, that’s what bankruptcy laws are for.” He explained that a number of his clients were uninsured adults who had faced enormous medical debts. He got bankruptcy judgments that let them pay pennies on the dollar. Apparently he took these cases not as cautionary tales but as inspiration.

Leave aside Obamacare’s absurd restrictions (which must be repealed) that virtually killed off catastrophic insurance plans, like the kind I used to have. How many young, healthy Americans who normally would shell out a few hundred dollars a month for catastrophic insurance don’t do so, because they are counting on Chapter 11 as their “insurer” of last resort? Morally, such people are no better than illegal immigrants who expect free medical care at emergency wards. In fact, as well-educated Americans with better options, they’re actually worse. Obamacare’s individual mandate was a ham-handed, probably un-Constitutional attempt to address this very real issue. It’s young, healthy people like my friend who make an insurance pool viable. If they don’t fear that medical debt could ever do them serious harm, many will not buy insurance. So the system will totter and fail.

No reform of health care in America will really address the fundamental problem of “free riders” jacking up costs for the rest of us unless it removes the legal obligation of medical professionals to work unpaid in non-emergency cases — and reforms bankruptcy laws that allow those who are willfully uninsured to essentially cheat the doctors and nurses who cared for them.

And now I leave it to the wonks to sweat the details. (For more from the author of “Why the GOP Can’t Seem to Banish Obamacare” please click HERE)

Follow Joe Miller on Twitter HERE and Facebook HERE.

The lying being employed to preserve Obamacare has likely surpassed the degree of intensity of the Gang of Eight immigration bill when Republicans were trying to convince conservatives the bill was the opposite of what it actually did.

At the time, they lied about the nature of the bill, its outcomes, its cause and effect, and the entire premise behind it. They used conservative talking points to describe something antithetical to what was actually in the bill while at the same time telling us lies about the legislative process. Allies of GOP leadership also managed to get liberal groups to fund ads in conservative districts selling amnesty as border enforcement.

All of those elements are playing out this week — except the stakes and magnitude of the lying is worse.

They are repealing Obamacare and not repealing it at the same time!

Out of one side of their mouths varying establishment figures say #RINOcare is full repeal. When we demonstrate that it’s not, they blame the Senate parliamentarian and congressional process. They say we cannot repeal the price-hiking, competition-destroying regulations that form the core of Obamacare because the parliamentarian won’t allow those provisions through the budget reconciliation process.

A logical observer of this subterfuge would ask the following question:

“Wait, so you mean you are now changing your argument from “yes, we are repealing Obamacare” to “no, we are not repealing Obamacare because the parliamentarian ate our homework”?

Privately, other leadership figures will tell rank-and-file members that we can’t repeal the regulations because of political considerations. They are too scared to explain how the pre-existing condition element of Obamacare is the core element driving up prices and inducing a death spiral of insolvency.

Which begs the next logical set of questions:

What is the official story-line of Republicans promoting this fake repeal bill? Do they not want to repeal it? Can they not repeal it because of process constraints? Or is this bill itself actually full repeal of Obamacare, as they keep advertising to the public?

All three choices, evidently!

The parliamentarian excuse is a bald faced lie and here’s the proof

As for the question of the parliamentarian and the budget process, we have already thoroughly debunked the myth that the regulations cannot be repealed through reconciliation. Based on precedent, CBO’s analysis, the courts, and the power of the vice president (presiding officer of the Senate) to overrule the parliamentarian, the regulations can all be repealed in a one-sentence bill. Republican leaders, who are owned by the Obamacare-loving Chamber of Commerce, just don’t want to do it. There are cants and there are wonts. This is a clear example of wont.

But here’s further proof they are lying to us about the constraints of the budget reconciliation process. The fine print of their own bill self-incriminates their contention that regulations cannot be repealed through the budget reconciliation. I noted before that the Congressional Research Service lists 24 regulations in Obamacare. The heart and soul of what drives up the costs are the core regulations of guaranteed issue, community rating, and the requirement to cover a panoply of wasteful costs. Those elements are what has made Obamacare insolvent because they force insurers to cover everyone under every circumstance for every disease at the same price of the general public. It takes the concept of insurance out of insurance. Hence, the crushing costs for everyone and the lack of choice and competition.

However, there are a bunch of other regulations that have a much smaller impact on the marketplace. Two of the 24 regulations are actually repealed or modified in this GOP bill. They are called “actuarial value” and age-rating restrictions. They will only have a negligible effect, especially because actuarial value is not repealed until 2020, long after the death spiral will occur.

It’s not important to get into the details of what these regulations do, but the inclusion of them in the GOP bill demonstrates incontrovertibly that when Speaker Paul Ryan, R-Wisc. (F, 51%) wants to stick regulation repeal into budget reconciliation he can. There are also several other extraneous provisions in the bill that don’t have a positive budgetary effect, yet Republicans don’t seem to worry about the parliamentarian striking them out of the process.

The bottom line is that the parliamentarian has no right to subject every individual provision of the bill to the “Byrd Rule” (requirement to have a budget effect) instead of looking at the entire bill in totality as a net budget cut. Ryan is simply lying when he says we can’t repeal guaranteed issue and community rating, which have a much greater budgetary impact than almost anything else he does include in the bill.

The lie about a second and third effort at repeal

Paul Ryan and administration officials also promise us that there will be future repeal efforts.

First, let’s just note for the record that this in itself self-incriminates their other lies; namely that the current bill is full repeal and will bring down prices and/or that full repeal is not politically feasible. Be it as it may, they are trapped in another double lie. If it is their contention that the parliamentarian has judicial review over the majority party and the future of our health care, then we never have the ability to repeal the worst elements of Obamacare. Nothing will change in the future. They should admit this point publicly and stop lying to the voters.

Under the GOP establishment’s assumption that budget reconciliation constrains them from repealing the regulations and enacting conservative reforms, we will have this same problem in “round two” and “round three.” The only other options for passing any conservative bill would be to eliminate the filibuster or enforce the “two speech rule,” which they have expressed no desire to do. What we can or can’t do on round one holds true for every round.

There are many more lies to debunk and will have to be addressed in future articles. For example, Ryan said that the regulations can be repealed administratively by HHS Secretary Tom Price. Aside from the fact that Republicans have demonstrated they don’t want to repeal them, this is simply not true. [read more here on that point ]

What is really playing out is reminiscent of ancient Persia whereby “a writ that is written in the name of the king and sealed with the king’s ring cannot be rescinded” [Esther, 8:8]. No Democrat policy — no matter how destructive and illogical — can ever be repealed because of the lies promulgated by the political class. They lie to us about the nature of the policies and they make up excuses to avoid repealing those policies in order to cover their original lies. Sadly, while Democrats lie in pursuit of their goals and aspirations, Republicans lie in pursuit of the other side’s ideals. (For more from the author of “Lie, Lie, Lie: Ryan and Co. Caught in Twisted Pretzel of Lies to Preserve Obamacare” please click HERE)

Follow Joe Miller on Twitter HERE and Facebook HERE.