Posted by: Francis Koster Published: March 12, 2017

The Morality Of The “Repeal and Replace” Discussion

It might surprise you to know that total healthcare spending in America is more than $10,000 for every man, woman, and child – annually.[1]    This total includes the money paid by private insurance companies, the Veterans Administration, Medicare, Medicaid, and the money paid directly by patients to doctors and hospitals, divided by the number of citizens.   This is a big problem for you – and your kids.

On top of this, we do not get our money’s worth.  According to the CIA, we are ranked the 42th country in the world for life expectancy[2].  Equally shocking, we spend just about twice as much per citizen as any other developed “rich” country where people live longer.[3]

To be clear –the current national debate about keeping or repealing ObamaCare is not about the work done by doctors or nurses– it is about how to pay for it.

Imagine this: You discover a neighbor is suffering.  If you go to your place of worship for guidance, you get pointed toward charitable behavior.  Go to your accountant or look at our own taxes, you get pointed in a different direction.  You are in a moral dilemma.

Just following the money (not the care given), there are least 8 menu items you and your kids can choose from to fix this mess.  What factors do you take into account, and how do you explain your choices to your children?

FIRST, we could remove the current law, put in place under President Bush[4], which restricts the federal government from negotiating lower drug prices with the pharmaceutical industry, currently ranked the third most profitable segment of the stock market.  (In 2016 the tobacco industry was second most profitable, and Wall Street investment managers were first[5]).    

And/or SECOND, we could protect and increase environmental regulation. Multiple studies, including a recent one by the Office of Management and Budget, found that for every dollar in expense caused business by environmental regulation, between $4 and $10 in taxpayer healthcare costs were saved.[6]

And/or THIRD, we could raise taxes on some industries that damage public health, like we did when we taxed cigarettes. For example, obesity is currently the fastest growing threat to public health in America, accounting for about one dollar out of every five spent. [7]  We could heavily tax those food items like sugar that cause obesity, raising prices significantly which has been shown to lower consumption, and reduce obesity, while raising tax dollars to subsidize healthcare.

And/or FORTH, we could eliminate taxpayer subsidies to companies like the oil, gas or coal industry that increase our annual healthcare bill.  The subsidy is around $37.5 billion annually, not counting healthcare costs, which are significant.[8] For example, for every 12 jobs in the subsidized coal industry in America, one citizen dies from the health effects of coal every year.[9]

And/or FIFTH, we could have deliberate transparent financial rationing of healthcare – which could be done by an approved list of treatments allowed under defined circumstances.  For example: 

 a) Your child has cancer and are relatively young and healthy – the financial rules could say “welcome to the cancer ward”, or

b) Your mother has cancer, and is obese, and elderly, and diabetic – the financial rules could say “welcome to hospice” (unless you are rich).

And/or SIXTH, we could have rich people subsidize portions of poor people’s healthcare insurance cost, and borrow the rest.  Congress would make some national statement like “The amount the rich people are going to contribute to your healthcare insurance costs through taxes helps a lot, but does not do the whole job, but we have decided that the government will borrow the rest to pay poor peoples healthcare bill.   Our kids will have to pay off the debt you build up, or the country will go bankrupt.”  (A proposed version of “Remove and Replace Obamacare” now being considered by Congress proposes this.)

Before choosing  # SIX, be aware that the Treasury Department says that total debt of the United States is now at 20 trillion dollars[10] (about $61,000 per citizen)[11], and growing rapidly about $19,000 per citizen per year[12].  Controlling our national debt is another serious issue tightly linked to paying for healthcare. Fiscal Conservatives are not wrong about the need to control our debt and deficit spending - although given the return on investment potentially created by borrowing to pay for preventive medicine they could be failing to recognize the difference between and 'expense' and an 'investment'. 

And/or SEVENTH, we could say to the poor people “We are not going to increase the national debt to pay for your healthcare – but here is some money the governmenttook from rich people in taxes.  Since there are many more poor people than there are rich people, the rich people do not want to pay $10,000 per year for each poor person. So the legislature decided they are only going to give each poor person a portion of what is needed.  Do the best you can.” (One of proposed versions of “Remove and Replace Obamacare” does this). (If the rich do not pay enough, see option EIGHT.)

Or EIGHT, if poor people cannot afford $10,000 annually per person, and we do not chose one or more of the first seven choices, we can let market forces dictate, and say, “that is too bad”, and let the poor people die painful early deaths. 

Let me know how your chat with your kids and your preacher goes.






[6]  Note:  I had to use a secondary source because the current administration has removed the original document from the internet.






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Francis P. Koster Ed.D.

Proven local solutions to national problems.


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