As one who has worked in the medical health care system for over 30 years, let me cut through the complexity that so paralyzes many of our legislators to reveal that there are only two issues at stake in a "repeal and replace" legislation.

The first issue is the key issue.  Americans – even those making 50K-100K per year – can't afford their premiums and deductibles.  I have two sets of relatives who each pay about 25K per year per couple for their health care insurance, along with 5K deductibles.  Last year, one had a colonoscopy.  That cost this person 3K out of pocket – even after those 25K premiums.  Try that actuality if you make 70K per year and your take-home pay is only 53K!

This first issue is what it is all about – health care must be made affordable.  If this can't be done, then the entire edifice crumbles.  Affordability shouldn't be just about having the taxpayer come to the rescue, either.  Affordability means competition, cheaper drugs, cheaper technology, and some hard (never mentioned by our leaders) choices.  (On that topic, check out the number of socialized medicine countries that have tough age restrictions on cancer care or transplant procedures, or don't even cover expensive procedures like liver transplants.)  So say loudly to your senators and congressmen (especially if you live in Maine, Alaska, or West Virginia) that affordability is the key issue.

The second issue is "fairness" – i.e., accessibility of health care to the poor.  This is a key moral issue for all of us.  How do you allow for a person making less than 15K per year – or on welfare – to get a life-saving liver transplant that will run into the millions of dollars?  Issues like this are not simply for the bleeding hearts – they define the moral character of a society, of its people.

But don't equate the two issues.  They are not equal.  If the first is not addressed soundly and clearly, the second issue has no hope, either.  If a country starves its farmers, nobody will eat.  And that includes its poor.  People need to realize that this is Earth, and Earth can be a tough, harsh arena, not given to free lunches.  Some need a free lunch, but that lunch will have to be provided through the sweat of those able to provide it.  If you shaft those people, then it all comes crashing down.  The left conveniently obscures this reality.

So tell your legislators that there are two issues here and that both matter, but survival (of all) says the first takes priority.  Only then can the second issue be addressed.  It is the sane – and moral – thing to do.