During the last two days, the press has given us a continuous back-and-forth concerning the GOP attempt to repeal and replace Obamacare.  The Democrats now claim that the effort by Trump and the GOP will "make America sick again."  For his part, Trump has labeled Sen. Schumer and his minions as clowns.  All of this is going on with two weeks before Trump takes his office.

The first issue for the GOP to remember is that they won the election, while the Democrats were soundly defeated nationwide.  The ACA was a paramount issue in this election.  The Schumer group will undoubtedly filibuster real reform, since their aim is to eliminate the private health insurance system, creating a federal single-payer system.

The budget reconciliation process allows for defunding of subsidies and bureaucracy while eliminating the 20 or so taxes in Obamacare.  It may not be possible to reconstruct a workable system initially.  The Democrats may resist the dismantling of the regulatory system Obamacare has wrought.  The GOP must remember that of the 20 million Obamacare policy holders, few are likely GOP voters.  Many of the up to 10 million persons who lost their private insurance are more likely GOP supporters.  Those burdened by high deductibles and high premiums are likely GOP voters.

Obamacare altered the McCarren-Ferguson Act regarding state control of insurance regulation.  Without complete repeal, the states will return to their 75-year tradition.  The Congress could employ the good aspects of the ACA such as the ability to purchase insurance for children until age 26 (at higher cost) and the ability to purchase insurance with pre-existing conditions.  They can add to that the ability to purchase across state lines to increase competition.  Further, they can expand health savings accounts for individuals.  For those unable to find affordable insurance, individuals could purchase Medicaid on an income sliding scale, determined by the states. 

The attempt to remove the 27,000 pages of regulations will result in lower premiums.  Allowing insurers to create different policies will slow the growth in premiums.  This is possible despite the obstacles liberals are posing.  Many Democrat senators from swing states up for re-election in 2018 will consider compromises.  Will Republicans possess adequate negotiating skills not employed for eight years? 

The ACA is in the death spiral.  We did not get to keep our plans, doctors, or hospitals.  It did not reduce costs.  The promises from Obama were not fulfilled.  For the first time in a century, average life expectancy has gone down.  Death rates for many illnesses have increased.  This is evidence of the failure of Obamacare.

Betsy McCaughey has stated that real reduction in health care costs occurs only when people die.  Preventive care uncovers additional illnesses that must be treated.  Dr. Oz believes that only through weight reduction and better lifestyles can health care costs be managed.  We cannot solve this issue easily, but the private sector will innovate to control costs while the federal bureaucracy will continue to become bloated.  Reform of health care must eventually include Medicare and Medicaid.  The Veterans Administration must be reformed also to control costs and quality care.

Hopefully, Trump will be allowed the latitude to propose these kinds of changes.  However, the Congress is the final arbiter of any reform.  We will discover Paul Ryan's and Mitch McConnell's real skills during the next few months.