Instead of mourning the expected repeal of the Affordable Care Act, let’s hold President-elect Donald Trump to his pledges on health care, while also meeting the test set by President Obama.

“If you in fact can put a plan together that is demonstrably better than what Obamacare is doing, I will publicly support repealing Obamacare and replacing it with your plan,” Obama said in early January.

There is one such plan, one that Trump has also admired in the past. It’s called Medicare for all.

Here’s what Trump and his team have said:

“We’re going to have a health care that is far less expensive and far better,” said Trump, at his Wednesday news conference.

“We don’t want anyone who currently has insurance to not have insurance,” said Kellyanne Conway, a top adviser to Trump, on Jan. 3. “Also we are very aware that the public likes coverage for pre-existing conditions.”

Yet, none of the proposals floated by congressional Republicans as the replacement for the Affordable Care Act would come close to achieving any of the Republican president-elect’s lofty words.

Those proposals include:

Offer health savings accounts. A boondoggle for Wall Street and only works for those with healthy bank accounts and healthy bodies.

Sell insurance across state lines. Unpack the rhetoric and you get a system that permits insurance companies to adopt the loose standards of the least-regulated states to evade patient protections in states like California that were hard won by nurse and consumer advocacy. These include limits on abuses by health maintenance organizations, such as barring lifetime caps on insurance payments for care and restricting insurers from dropping patients from coverage when they get sick.

Form high-risk pools for people with pre-existing conditions. Intended for the sickest patients, such pools typically have extremely high premiums and deductibles with huge coverage gaps.

Issue tax credits to replace the Affordable Care Act subsidies for plans. This too would fall far short of enabling low- and moderate-income individuals and families to buy insurance, especially without any real plan, as Trump himself is demanding, to limit the price-gouging that is endemic to a private-market system.

All those schemes threaten to dismantle what remains of our social insurance commitment and public safety nets, and further expand a market-based health care system premised on profits and ability to pay. This is the same system under which the U.S. is ranked last among 11 wealthy nations in efficiency, equity and outcomes as recently as a 2014 Commonwealth Fund study on the eve of the full Affordable Care Act implementation.

Most other industrialized countries have a national health care system similar to our Medicare to guarantee health care to all their people. Improving and expanding Medicare would also meet the other promises made by President-elect Donald Trump.

Any of the proposals devised by the repeal-and-replace crowd would herald a return to the bad old days of an escalating health care nightmare.

It’s not enough to just protest the repeal. Democrats should demand the incoming administration and the Republican congressional leaders adhere to the commitments Trump made to the American people by implementing the only plan that would work — Medicare for all.

Original Post: http://www.sfchronicle.com/opinion/openforum/article/Instead-of-protesting-Obamacare-repeal-seek-what-10854353.php