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I might feel more sympathetic to calls for repealing health care reform if I had any sense at all as to what was going to replace it.

I certainly don't want to go back to the bad old days of premiums doubling every five years (killing jobs) and millions of uninsured patients walking into emergency rooms and getting what (for them) was free treatment that the rest of us effectively paid for.

By now, everyone should have figured out that the hospitals and insurance companies just pass those costs on to us. If we don't pay directly for those increases, our employers are taking it out of what could have been higher salaries or bonuses.

The engine driving the call for repeal is the mandate that everyone is forced to buy coverage. Yet, without this provision, you can't have a system that guarantees coverage at reasonable rates for those who have pre-existing conditions.

A world of guaranteed coverage only works if you have healthy people paying premiums to offset the costs of those who need expensive care. Today's healthy person, of course, could be tomorrow's patient getting radiation therapy, but this gets lost in the harangue.

An alternative to the mandate, suggested by Richard Thaler in the New York Times, would be a provision that bars anyone who opts out from being able -- after the need arises -- to buy conventional insurance at rates subsidized by the government. The rest of us would be protected from someone trying to game the system.

Such an idiot, if they had any assets, would then probably be forced into bankruptcy in the event of even a relatively minor health problem.

A night in intensive care can be $30,000. Someone a little dehydrated can spend $1,000 in an emergency room getting a saline solution drip.

Today's greatest cause of personal bankruptcies is uninsured hospital costs.

A few people losing their homes because they were offended by the mandate might prompt the rest to feel a little better about having to buy subsidized coverage. Nobody will get a free ride.

Unfortunately, we're back where we started from when a bankrupt or indigent patient is wandering once again into the emergency room for treatment.

In a typical city, a relative handful of patients make up the majority of the total cost of the uninsured that the rest of us have to pay for.

Nothing in today's broken system offers any incentive to offer preventive medicine or proactive treatment to these people.

Unless you're Kaiser or one of the nation's few "single payer" delivery systems like the Veterans' Administration, there's no financial incentive to keep people well.

The insurance and hospital industries actual thrive on these people. the New York Times (there I go again) last Sunday covered the case of one, 560-pound patient who had cost the insurance-buying public more than $3 million dollars for a variety of ills. I wish those repeal zealots would offer some fix for this problem as part of their "better idea" now that they've made "single payer" a dirty word.

The new health care law will fine people who don't want to buy insurance, and the fine is collected when they pay taxes.

What about people who don't pay taxes? The idea of just barring people from coverage if they failed to sign up when they had a chance may be easier to enforce.

As for the states who are supposedly threatening to opt out of the federal program, we'll see how popular their lawmakers turn out to be when it dawns on voters that the popular provisions of the plan are toast and that they have lost the federal dollars that are available to fund those subsidies.

In the Reagan era, we withheld federal highway funds to states that wouldn't adopt the age 21-year-old, minimum-drinking age.

A few holdouts finally decided that the law wasn't so unconstitutional after all.

I have yet to see anything having to do with repeal that suggests viable alternatives. Fining non-enrollers or barring them from coverage are the only alternatives. Pick your poisons.

The one poison I never want to taste again is a nation of my Baby boomer contemporaries who were between jobs, uninsurable and threatened with the possibility of bankruptcy.

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