The Register's Editorial: Focus on improving, not killing, Obamacare

The Des Moines Register's editorial board has been interviewing candidates for the Republican nominations for U.S. Senate and U.S. House of Representatives in the 3rd Congressional District. One after another, these individuals say they support repealing the Affordable Care Act, which is commonly known as Obamacare.

The law has provided protections and health insurance to millions of Americans. But the message Iowans who have gained insurance under the law hear when these candidates speak: Elect me and I'll work to take away your coverage while offering no viable alternative to help you.

We recognize that the health law is unpopular. But those seeking office should acknowledge the reality of the situation: President Obama will be in office for another two and a half years, and he isn't going to allow his signature law to be repealed in that time.

The law is being implemented in every state. If these candidates truly want to improve access to health care for Americans, they need to offer some fresh ideas on how they would do that, because the ones they are proposing are the same narrow, ineffective ones pushed by their predecessors.

Candidate Mark Jacobs, for example, is among the many who advocate for tort reform as one of the solutions for addressing problems with the health care system. The general goal with such an idea is to limit what patients can collect in damages if they successfully sue a doctor for malpractice.

Limiting monetary awards sounds like a great idea for medical malpractice insurers who pay these damages. But even if there are caps on what patients can collect, that doesn't mean it will translate into lower malpractice insurance premiums for doctors. Even if it did, it doesn't mean doctors will pass those savings on to their patients. And tort reform does not get a single American health insurance.

Several candidates have talked about people taking "personal responsibility" for their health care by shopping for the best prices on drugs and medical procedures. This is easy to do with drugs, where a consumer can ask for a cheaper generic instead of a brand-name medication.

Good luck shopping for the best price on a pacemaker or appendectomy. When you show up in the emergency room with chest pains, the last thing you will ask the doctor is whether this hospital is less expensive than one down the street.

Candidate Sam Clovis is among those advocating to allow people to purchase insurance across state lines. Ask a 40-year-old diabetic or a 55-year-old with heart disease who is shopping for his own health insurance if the insurer in Minnesota is offering a much better deal than the one in Iowa. The answer would be no. That's because no insurer wants to offer him affordable health insurance.

Insurers would simply gravitate to states with the most lax regulations and coverage requirements and sell policies to people across the country. That might work for a healthy person who doesn't need comprehensive coverage. However, less healthy people would look to states that require coverage for services they need, and they would likely pay more for insurance there.

None of the ideas being floated by GOP candidates help Americans with preexisting conditions find affordable, comprehensive coverage. None of the ideas protect people from losing insurance when they get sick. None of the ideas address the escalating cost of Medicare.

The new health reform law does those things. So when candidates say they support repealing Obamacare, Iowans should press them for more details. Ask them to explain how tort reform would insure more Americans, rather than simply fatten the profits of malpractice insurers or the physician. Ask them to describe how someone they know "shopped" for the best price on cancer treatments, heart surgery or end-of-life care. Ask for ideas other than rooting out "waste, fraud and abuse" to control costs in Medicare.

Before Obama was elected and Democrats gained majorities in Congress, Republicans could have dealt with the serious problems with health care. That didn't occur. When those Republicans roll out the same tired ideas for "reform," it is hard to believe they will do it in the future.