Improve the law instead of pursuing a repeal

To Gary L. Maydew

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To think of the Affordable Health Care Act, envision a house, a massive house with dozens of rooms, expensive and lavish, but one that does not rise to the level of a mansion because of its poor architectural design. The house was hastily constructed with sloppy carpentry and little planning. Further, the house has several rooms that cannot be used for their envisioned purpose or seemingly have no purpose.

Tearing down the house would be tempting, but very expensive, likely not even permitted by the zoning authorities (and a number of tenants already occupy the place). However, the house can, though not without difficulty, be repaired.

Such is ObamaCare. Republicans can fume at the poor construction of the law, rue the loss of freedom that arises from the law's mandates, emphasize its inconsistencies and untruths and point out that the law will create a much larger deficit than promised. None of this, however, will alter that the chances of repeal are slight. How many times in the last 60 years have the Republicans controlled both houses and the White House?

So it would be much more constructive for them to work to improve the law. Here are some changes that would be constructive and have a chance of passage:

l Replace the mandate.

The mandate to buy health insurance or pay a penalty is indeed a tax, levied on young, healthy people to support medical payments on behalf of those who are very unhealthy. Bemoaning the high education debt of those in their 20s and 30s while also taxing them makes little sense.

How to then keep guaranteed insurability while keeping insurance affordable? Replace the mandate with a refundable tax credit that gradually phases out as family income passes a certain level - say four times the poverty level. Families would use the credit to pay for the inevitably higher health insurance that will otherwise result from guaranteed insurability. Fund the tax credit with an across-the-board surtax on all income.

Yes, Republicans would have to abandon their no tax increase pledges. Better to create a health care tax, the cost of which is transparent and born by all, than to have the cost be hidden and born mainly by the young.

l Eliminate the

2.3 percent excise tax on medical device manufacturers.

In addition to violating horizontal equity (other players in health care do not bear this tax), the tax will hinder the development of major contributions to the improved health of our citizens. The lost revenue could be recaptured by reducing the deduction currently allowed for domestic production activities.

l Eliminate the

3.8 percent tax on investment income.

See reason above.

l Strengthen health savings accounts and health flexible spending accounts (instead of reducing their effectiveness, as does ObamaCare).

Strengthening the nexus between the payer of medical costs and the provider of the medical costs would be the most effective way to eliminate the unnecessary medical tests that push up our medical costs. To be effective, this would have to be combined with laws prohibiting hospitals and other care providers from charging individuals more than those covered by group plans.

Admittedly, these provisions would be a hard sell. But Republicans could work with centrist Democrats (many of whom are nervous about the unpopularity of the mandate). The alternative for Republicans is to flail angrily, with votes that accomplish nothing and indicate only obstreperousness and inflexibility.

Working to improve a flawed law is more constructive.

Gary L. Maydew of Ames is a retired accounting professor at Iowa State University. Comments: glmaydew@hotmail.com