"Repeal Obamacare" is Irresponsible. There are Better Ways to Address the Shortcomings of the Affordable Care Act

The Disease Management Care Blog has decided on two things for the 78 days between now and the midterm elections:

1. It's not going to drink bottled water. The claim of better taste is questionable and the waste of energy and plastic is atrocious. If the DMCB was worried about the safety of its public water supply (and it's not - water is safer than ever), it would petition local government to do something. It figures that if it's going to be environmentally responsible, the DMCB would be better off recycling these kinds of containers.

2. It's not going to vote for any candidate spouting silly rhetoric over the "repeal of Obamacare." The odds of prevailing against a Presidential veto are likewise questionable and the waste of political energy would also be atrocious. The only merit to a repeal debate is that every minute spent on that would be a minute less spent on crafting more ill-considered legislation - from both sides of the aisle. Our Republic deserves better.

What could responsible candidates offer as serious remedies to flaws in the Affordable Care Act that are within political reach? If they must, the politically naive DMCB sees two categories:

1. Blocking: In its role of keeper of the purse strings, Congress can withhold or alter the funding of the more questionable parts of the bill. One option is to underfund that part of the budget of the Internal Revenue Service (IRS) that will need to be expanded to support the controversial mandate. Another is to squeeze the funding of the Center for Medicare and Medicaid Innovation.

2. Tackling: During and after the health debate, the DMCB recalls hearing a lot of good ideas on how to keep the ACA but make it better. Examples include allowing for a more rational interpretation of the medical loss ratio, rethinking the not-so-obvious merits of electronic records, coming up with meaningful tort reform and preserving what's good about Medicare Advantage with smarter funding.

The DMCB looks forward to hearing more about the "blocking" and "tackling" options from the conservative candidates. Both issues have downsides. Both will test the mettle of the Republican opposition. Both will tempt the Republicans to take either a) the easy, visually appealing and scientifically bankrupt "bottled water" approach to health care reform or b) the sound common-sense approach of relying on what works.

We'll see.