Last Thursday, the Supreme Court found that the mandate in the 2010 Healthcare Law, that Americans who can afford to buy health insurance must buy it or pay a tax penalty, constitutional which was great for America because it leaves the Federal government with the tools it needs to fix America's healthcare system! Though what is heartbreakingly disappointing about this law is that neither political party is really focusing on the alarming problem created by this law which is the cost of the law's new entitlement program. This law creates a new health insurance program beginning in 2014 where the federal government expands medicaid and will pay at least ninety percent of the premium health insurance cost for Americans making up to 400% of the poverty level if their employer doesn't provide health insurance. This program is going to create a financial Tsunami on the Federal Budget, first this program will dramatically increase health care use amongst lower/middle income Americans because it makes health care affordable which will dramatically increase the Federal governments health care costs. Secondly, the great deal arrangement of this program for enrollees will incentivize employers of high numbers of lower/middle income workers to drop their employer sponsored health insurance its cheaper for the employer and for the employee it frees up money on the employers balance sheet to increase wages which will jack-up big-time the price of this program on the federal budget. At minimum, this entitlement program will cost tens of billions of dollars more a year than planned and frankly a prudent assessment should conclude that once employers en masse start dropping their health insurance this program's cost will exceed plan by figures approaching $100 billion per year, this is not sustainable for America! Both parties are off message on the health care law from what a good American once to hear which is how to solve this financial Tsunami created by the law. The Democrats don't want to talk about the law because if it is talked about a spot light will be shown on the serious financial problems created by the law they just want the law implemented so that millions of Americans will experience the good feelings created by the law's benefits the cost problems they'll deal with later it doesn't matter to them that there may be irreparable harm to America's health care system, its finances and the work it does over this course. The Democrat leadership knows quite well the serious financial problems caused by this bill, the Obama Whitehouse has given waivers to a thousand plus employers over this law because the financial effects of this law on these employers is too severe. The Obama Whitehouse has circumvented the revenue raising portion of this law vis-a-vis the Medicare Advantage program where the plan was to cut the yearly stipend these private insurance companies receive for each enrollee the Whitehouse doing this by giving these companies additional comparable amounts of money under the guise of a cost-reduction Medicare program. Even the Congressional Budget Office has recognized that its 2009 and 2010 projections on the costs of this law were wrong and the Democrats waived those projections around when the legislation was a bill in Congress like they were a financial vaccine for the country from any harm over this legislation. The Democrats are really being foolish about not addressing the financial Tsunami created by the entitlement program in this legislation because Republicans and Democrat Congresspersons over the ensing years are not going to let this program ruin the country financially they are going to extract cuts in other federal programs to offset the expenditures from this program and what most likely will they will cut is education, food and energy assistance spending and the like spending Democrats rightly hold dear; further, this program is long-term unaffordable for America the country is running trillion dollar yearly deficits and the government's dysfunctionality makes it impossible to stop this course so it is only a matter of time many experts say well within a decade that the sovereign debt markets will shun America and when this time comes the Federal Government will be forced to make drastic and devastating federal spending cuts which will include such cuts to this entitlement program. The Democrats should do the sensible and right think and support now reforming this entitlement program to make it affordable when implemented and long-term into the future! The Republicans fare no better than the Democrats over their current behavior on the law. The Republicans approach is throw everything including the kitchen sink at the law hoping enough criticisms stick to pull down the law. The Republican approach treats the American people as if their stupid which is a big miscalculation. The American people recognize that their is a lot of great things about this law and we don't want to see it go away. This law stops insurance companies from dropping people when they get sick. It stops lifetime claim limits on health insurance and makes yearly claim limits reasonable. It allows people to keep their children on their insurance until they reach the age of twenty-six. This law in 2014 will stop insurance companies from rejecting applicants because of a pre-existing condition and stop them from charging higher premiums over such a condition. It gives people with insurance the rights to have an outside party hear their appeal in a dispute with their insurance company. A huge benefit of the law is the provisions requiring insurance companies to spend at least eighty percent of the monies they take in on premiums paying health care claims and give any short fall back to the enrollees in the form of a rebate. The Republicans are really ridiculous in their behavior over the law. Currently, their making a big deal that the Supreme Court found the law's mandate penalty to be a tax so now their trying to spin the law as a tax increase on the middle class; the American people see that this tax only applies to people that can afford to buy health insurance and don't and they know these people increase the cost of everyone's healthcare because when these free riders get sick they often don't pay the hospital or doctor monies owed to treat them so the cost gets passed on to everyone else, most American's see tax criticism as hollow. The Republicans clamor that the American people don't need regulations from Washington on health insurance they only need to allow the free market to work; this couldn't be further from the truth, most Americans believe they need the Federal Government to protect them from being mistreated and taken advantage of by the insurance companies whether that be over the dropping people when they get sick issue or penalties over pre-existing conditions, unreasonably low yearly and lift-time claim limits. Republicans forget that for decades now many Americans have had bad experiences with health insurance companies and their trust of them is very poor for one they had to deal with that hurdle that was prevalent for many years that if you wanted to have a medical condition treated that required the need of a specialist you had to get a referral from your primary care physician or the insurance company wouldn't pay for the treatment from the specialist. The big problem with the Republicans over the 2010 health care law which is why this issue won't make a difference for them in most elections in 2012 is that the Republicans aren't offering the American people a good alternative, an alternative that meets their and their neighbors needs. The Republicans offer a repeal and replace agenda for the law. The replace legislation doesn't offer a ban on yearly and life-time claim limits, a common illness like cancer can cost $200,000 to $300,000 to successfully treat people could be financially wiped-out or prevented from being able to afford care with often seen insurance claim limits. The replace legislation offers no protection against insurance companies penalizing people over pre-existing condition when deciding to pay claims, prior to the 2010 law the American people would often see Americans who have gotten sick who had insurance have their insurance company say your current illness is from a pre-existing condition we won't pay for your treatment, the Republican party's position on this issue is not acceptable to most of the American people. The Republicans say let people decide for themselves what coverage they need, the Republicans are being rotten here with this argument line because most Americans don't have the extensive knowledge needed to insure their insurance would cover all the different type of medical treatments a prudent person would deem necessary if one would get a reasonably foreseeable illness. The Republican Party's replacement legislation offer for people, people that are working mind you, who can't afford health insurance today or who are getting crushed under the financial burden of their health insurance or because of cost considerations can only afford poor coverage health insurance is that the Republicans will allow you to buy health insurance across state lines and you can treat your premium cost like workers that get their health insurance through their employer you can exclude it from your taxable income. This is no good solution even construing this in favor of Republicans look at a common example take a worker with a wife and two kids maybe he can find decent health insurance through this system for as low as $7200/year which turns out to a cost of $150.00/week which is still unaffordable for most low and middle income Americans. The Republican Party's replacement legislation solution for people with pre-existing conditions is a complete dud they want to have the states come up with high risk pools where people with pre-existing conditions which are high risk enrollees will go and buy health insurance and the state pools will subsidize the premium costs for these enrollees so that their insurance premium costs are affordable. For this to work well for pre-existing condition enrollles these state pools would have to subsidize insurance premium costs to a high degree which would be enormously expensive for states to run in reality too expensive the states don't have the money to do this to be plain and simple. To really underscore the point that Republicans don't get it on the health care issue one needs to just focus on the appearance of Senator Majority Leader Mitch McConnell this past Sunday when he was being inteviewed by Chris Wallace, Senator McConnell super eloquently described the two major problems with the 2010 law that the law's mandates will make employer sponsored health care too expensive on employers thus suppressing job creation and the law (vis-a-vis the new entitlement program) is too expensive and unaffordable for America; the Republicans huge failure appeared when Mr. Wallace asked the Senator what will the Republicans do about the 30 million people that will get insurance through Obamacare and he kept asking the same question and in a moment of being candid the Senator said that is "not the issue" - to ordinary Americans that is exactly the issue a lot of employers currently don't offer health insurance and more in the future won't for affordability reasons so this issue will affect them and the Republicans offer no good solution on this problem. If Republicans are smart and good citizens they will recognize that the American people don't want the 2010 law repealed we want it dramatically changed, we want it dramatically altered especially in the area of mandates on employer sponsored health insurance and the cost of this new entitlement program whether it be the expansion of medicaid or the subsidies for people buying insurance on the exchanges. The American people want the Republicans to work within the new system created by the law we don't want to go back to square one and frankly the Republicans have a great opening here to gain votes because Democrats don't engender a lot of confidence with handling the purse strings of America the problem here to fore is that the Republicans offer a scarier future if put in control of the country's finances! Both the Republicans and Democrats should adopt the following views to fix the 2010 law. The essence of law's new entitlement program is good low and middle income Americans need government help to be able to get health insurance it's just too expensive for there to be any other way. Also, the design of channeling real low middle income Americans into medicaid is good because in many cases medicaid pays health care providers low fees which it should because it is covering low income people and the providers should thus understand and support the low fees. Channeling other program eligible Americans into the exchanges to buy insurance also is a good design for it will create large pools of enrollees which will produce lower premium costs. The laws plan to pay for this entitlement program is good, this law will add more people on to the insurance rolls and more onto good insurance rolls which will mean more business and more revenue for hospitals, pharmaceutical companies and medical product companies and it is only fair to divert (through taxes) some of that added revenue back to the Federal government to pay for this increase in customer volume. Further, it is fair to cut the stipend to Medicare advantage providers for this whole dichotomy in the present Medicare system is illegitimate; today regular Medicare enrollees are second class citizens the system spends less on them and there is no justification for this the only justifications for paying Medicare Advantage companies more money than is spent on regular Medicare enrollees is that if the Advantage enrollees are low income and the specific plan is an HMO type where the co-pays and co-insurance if there is any are significantly lower than regular Medicare which thus increases vital healthcare access for these enrollees and enrollees with serious healthcare problems that need to be well managed to keep down costs and the Medicare Advantage program offers such service. One major point that both Democrats and Republicans should be supporting is to do away with the law's mandate that insurance providers provide free preventive care; what have you lawmakers in Washington responsible for this mandate lost your mind how could a person be so detached from reality that would do such a nonsensical thing get elected into office in America it is truly unbelievable. First, preventive care isn't free the health care providers still require to be paid which means insurance providers have to pay them. Secondly, free preventive care incentivizes the use of medical care when it really isn't needed, for instance many many people under forty years of age don't need to be getting yearly physicals and the like in such cases preventive care provides largely no practical health wise benefit for them it is a needless expenditure of money. Thirdly, there is no conclusive proof that free preventive care saves money long-term or overall as a matter of fact many experts say it doesn't save money along these lines but it just makes for a better quality system which is lovely to pursue when America stops being in danger of sliding into a financial abyss! If Congress wants to mandate preventive care is not subject to a person's insurance deductable or that if a person is within his or her deductable the co-pays or co-insurance for preventive care can't be higher than twice what they would be if the deductable was met that would be fine at least there would be some incentive on people to be judicious about such healthcare use. The last point here is that Democrats and Republicans should coalesce around the idea that for this entitlement program on the exchanges the country to control costs and largely reduce the incentive for employers and employers wanting to end their employer sponsored health insurance and enter onto the exchange where the employees can get a government subsidy is make the entitlement program on the exchanges only subsidizing at a rate supporting catastrophic health insurance coverage; for intellectuals that might hear this idea and are inclined to be difficult let me add some valuable detail here. By catastrophic health insurance it is meant what is prevalently seen and described in the American economy as high deductable insurance like a deductable of $1200/yr for individuals and $2400/yr for families. A reasonable criticism of this idea would be that there is a lot of people in America that have serious long-term medical problems like diabetes or hypertension which need continual care or serious medical problems could result and we as a society shouldn't put up a real obstacle for those people getting the needed care which the high deductable would cause; the point is well taken so the healthcare law could mandate for high deductable insurance plans medical care for serious chronic health care problems is excluded from the deductable. It might be a good idea for Congress to mandate that for high deductable insurance plans for low/middle income Americans that is Americans with incomes under four hundred percent of the poverty level that the standard deductable definition shouldn't apply though something like a definition where insurance companies would be permitted to have such enrollees pay up to double the co-pays and co-insurance charges the reason for this suggestion is that high deductable insurance plans do overly deter the use of justified health care services for low income enrollees what is the fee for primary care physicians $125 and a specialist more such charges are too onerous on these Americans, it would be Congress could help here and still keep the low premium advantage of high-deductable health insurance programs!