Republicans need a Plan B

Should Republicans succeed in their attempt to get the new healthcare legislation overturned on constitutional grounds, what then? No one wants to see the current chaos of selective health insurance and rising treatment costs continue.

The best course for opponents of the law is not only to fight for its repeal, but also have a plan ready to take its place.

Few in the medical profession thought more about this subject or brought more experience and passion to it than Dr. Michael DeBakey the late cardiovascular surgeon.

In a speech delivered at Rice University in Houston on April 15, 2005, DeBakey laid the moral, medical, and political groundwork necessary to transform American healthcare. He called for a roadmap toward achieving a universal healthcare system that is "culturally acceptable, affordable, and of optimal quality, while avoiding its administration and total control by an ultimately rigid and unwieldy governmental or insurance-industry bureaucracy."

In each of these categories, Obamacare falls short.

In his speech, DeBakey remembers some history, much of which he lived (he died in 2008 at age 99). He recalled that national health insurance in the United States was first proposed in 1915 by the American Association of Labor Legislation, a small organization of fewer than 3,500 members. Interestingly, Samuel Gompers, one of the most influential labor leaders of his day, vigorously opposed universal healthcare. Gompers argued, "The solution to illness was not compulsory insurance, but higher wages."

In 1920, the American Medical Association (AMA) opposed compulsory insurance "which provides for medical service to be rendered contributors or their dependents, provided, controlled, or regulated by any state or federal government." As recently as 1990, the AMA continued to resist compulsory insurance and healthcare run by the federal government. Apparently seeing the political writing on the wall, the AMA reversed itself and signed on to Obamacare.

DeBakey saw the dangers of too much government meddling in healthcare, but he also realized something had to be done to cure its ills and that the federal government, which is very much involved in research grants to medical institutions, has a role to play. In his Rice speech, he said, "Blind opposition, indignant repudiation, bitter denunciation of these laws is worse than useless; it leads nowhere and it leaves the profession in a position of helplessness if the rising tide of social development seeps over them."

Which is what has happened with Obamacare.

DeBakey quotes Robert M. Ball, President Kennedy's commissioner of Social Security, who said that the architects of Medicare saw it and subsequent insurance for children as incremental steps toward national healthcare. He said he was "astonished" to learn this. He shouldn't have been because "progressives" always think government and academia are smarter and more capable than any individual or profession.

Seeing clearly the arguments that would be made in favor of Obamacare, DeBakey said, "I have traveled the globe to developed and undeveloped countries with both democratic and communistic governments . . . and I can state unequivocally that I have not observed any 'universal health system' or other state-operated medical system that functions in a highly satisfactory manner or provides high-quality care to all the people all the time. In all such countries, there are long delays for any form of high-technology care---sometimes with fatal consequences. In fact, rationing of care is a prominent feature of all these systems."

DeBakey was a humanitarian who believed "healthcare is too critical for the welfare of the people to be held hostage by the politically motivated or the profit minded. Herein lies the societal challenge: the need for accepting the desirability of some form of national healthcare, along with the willingness to pay for it, but avoiding its administration and total control by an ultimately rigid and unwieldy governmental or insurance industry bureaucracy."

This is the Republican challenge. If Obamacare is struck down, Republicans should have a substitute proposal ready that embodies their principles, but that also will require a Republican Congress to pass it and a Republican president to sign it in 2013.

© 2010 Tribune Media Services Inc.