The coming Republican debate over replacing ‘Obamacare’

With a U.S. Supreme Court decision on health care reform in the offing, Republicans are making preparations.

Near the top of the GOP food chain, we’ve heard Attorney General Sam Olens and U.S. Sen. Saxby Chambliss both declare the party that brings down President Barack Obama’s premier piece of legislation should be ready to cope with the fallout.

It is akin to Gen. Colin Powell’s attitude toward the war in Iraq: “If you break it, you bought it.” (Although one could argue that a system in which an appendectomy might cost $1,529 or $182,955 – depending on the color of a California hospital administrator’s mood ring – already qualifies as damaged goods.)

Given his experience in Massachusetts, former Gov. Mitt Romney may allow congressional Republicans the first crack at floating a substitute. Already, several are blazing their own trails, including U.S. Rep. Paul Broun of Athens.

Broun, a physician, has come to recognize that the expectation of guaranteed health care is rooted in the federal law that allows no patient requiring urgent care to be turned away from a hospital’s emergency room. Paul’s bill, among other things, would allow a nurse or medical technician to conduct the triage – looking for conditions that pose “immediate risk to life or long-term health.”

Uninsured sprained ankles or cases of flu could be sent packing.

The problem is that, three years later – vague assertions aside — even Republicans don’t agree on what health care in America should look like. Or what might replace the mechanisms that Obama and a Democratic Congress pushed through.

Consider a local example — the case of SB 288, a lil’ ol’ bill that died in the state Capitol last month.

Possibly, you’ve heard one politician or another declare that government ought to simply get out of the way of business. But in fact, some of the most bitter, long-standing fights at the Capitol involve one profession attempting to gain advantage over another – or force a competitor to surrender his protections. These guilds demand government involvement.

This year’s fight over SB 288 was quiet — and bitter. The measure sponsored by freshman state Sen. Charlie Bethel, R-Dalton, would have allowed pharmacists to give approved vaccines to their customers without a prescription from a physician.

“It’s a common-sense approach, it saves money, and it increases access to something that we know is good for public health,” Bethel said. All things that resonate in the current health-care debate.

Pediatricians warned that some young women might not want to confess a pregnancy that could be harmed by a rubella shot. Bethel amended his bill so that it only applied to patients who are at least 19 years old. (The north Georgia senator also excluded the vaccine for the human papillomavirus associated with cervical cancer – the vaccine for young girls that got Texas Gov. Rick Perry into trouble during his GOP presidential campaign.)

Only a few years ago, during the last big flu epidemic, the General Assembly passed legislation to permit pharmacists to administer doses of influenza vaccine. It is this door that Bethel wants to open wider. It is also his answer to those who raise safety concerns.

“[Pharmacists] can give a flu vaccine now. And they can administer any vaccine that’s prescribed by any physician — now,” Bethel said. “So that argument doesn’t hold water.”

Bethel’s bill easily passed the Senate. But it never came to a vote before the House Health & Human Services Committee, chaired by state Rep. Sharon Cooper, R-Marietta, a nurse.

“When you start giving live viruses, you need to do an in-depth health history, and you need to know the background on a person,” Cooper said. Some vaccines – against shingles, for instance – are dangerous to people with depressed auto-immune systems.

“People that are HIV positive should not get it. Do you think they’re going to stand in a pharmacy line and tell a pharmacist that they’re HIV positive?” she said.

The Medical Association of Georgia, which represents physicians and is a powerful lobbying force in the Capitol, opposed SB 288. Pharmacists, by and large, favored it. But they weren’t the only parties involved. “The most aggressive pushers were the retailers,” Cooper said. Think grocery store chains with large pharmacy operations, urging you to get that next shot.

“They see money. It’s not about patient care, it’s about money,” Cooper alleged. But this is not entirely so. It is also about what health care, at least in Georgia, should look like.

Will it be a drive-through at McDonald’s, or sit-down service at Denny’s?

Cooper argued for the need to establish and preserve the “medical home” – the place where a patient’s medical history lives. “That is a place where they know about you. They know what you’ve had, they know your records,” the House chairman said.

Allowing patients to wander from pharmacy to pharmacy, creating separate histories in several places, would “fragmentize medical care” in the state, she said.

We would likely pay less, but those in charge of our treatment would know less about us.
Both sides promise that the fight will continue next year – no matter which way the U.S. Supreme Court rules in June.

- By Jim Galloway, Political Insider

For instant updates, follow me on Twitter, or connect with me on Facebook.