"Honest, integrated and Ethical" anathema to politicians....

Yep, I also think Heinlein had a similar saying..

Oh I agree the system should be reformed, I think we just differ on how critical a repeal of the ACA is to the process.

Reforms other than repealing Obamacare should still be pursued. At best (and most likely) they will be implemented by Trump's people, and at worst they will not cause any harm.

That's one bet I'm not taking, especially when a bureaucrat shouldn't hold that authority in the first place.

For at least the next four years, we can assume that the Director of HHS would implement Trump's policies. So for the foreseeable future, Congress could implement many health care reforms without immediate repeal of Obamacare and without worrying about being undermined by executive action.

I agree with the proposals you present here.

However...

As the ACA is currently written, it delegates effective lawmaking power to the Director of Health and Human Services. We saw that with Sibelius (and Obama himself with the waivers). That being the case, any reforms are subject to override and veto by the Director of HHS as he/she sees fit. That authority MUST be revoked for any other measure to stand with certainty. IMO, repeal is not negotiable.

Why don't we each pay our own way, take care of ourselves preemptively and those with abundance and a will to help chip in for those that end up between a rock and a hard place. Give Doctors a tax break if they offer free or discounted services.
Also, I think that the allopathic, AMA cabal should take the hit when they screw up...which is just about everything they do to you.

The whole system needs to be Honest, integrated and Ethical.

I will not hold my breath though...

One other important way to force competition is to require hospitals post their charges for all services online. That is a suggestion from a former hospital administrator who was frustrated with the juggling of charges to make ends meet, charging some ten times what others pay. It's supposedly an attempt to make treatment affordable for all, but it's collusion between insurers and hospital board members aimed at profitability. As long as these practices are kept secret, competition won't enter the medical care marketplace.

Regardless of motive, my point is that you cannot repair an incorrect premise, anymore than you can alter the power of gravity so that it will suit whatever needs you might have. The only time any one size fits all health plan will work is when everyone has access to a machine that cures everything. Not on the horizon at present.

I agree with many of the things you say. There are things that can cut costs. At one time it was thought that non-profit hospitals could cut costs, but having worked for one for 10 years I can tell you that they operate on nearly the same basis as other hospitals.
Tort Reform would be a big step, eliminating huge judgements against providers, and allowing doctors to stop practicing defensive medicine by ordering every test and procedure under the sun, lest something be missed and they get sued for malpractice. But tell that to the trial lawyers.
The reality is that man does very little that does not involve making a profit. Medicine hasn't been a philanthropic enterprise since doctors made house calls, and accepted chickens for payment.
Even though I have worked in the field I don't know what the answer is. And yet I believe that an attitude adjustment on everyone's part is needed. Docs who spend up to 12 years or more to get their credentials need to get over the idea that being a doctor entitles them to Country Club living, a Mercedes Benz, a summer home, and private schools for the kids. Patients need to understand that not all outcomes are good, or work, that doctors are human beings and not perfect, and that a bad outcome doesn't mean that they just hit the lottery. Providers need to be able to stop overcharging some patients to pay for others, and that their new building doesn't have to be a Ritz hotel. And government needs to fully fund programs AT COST rather than passing mandates requiring services to be provided, and then reimbursing providers at 30 cents on the dollar.
However I am afraid I will never see any of these things in my lifetime. As my grandmother used to say, "Life isn't fair. You need to get used to it, and take your lumps."

Not always, that is a common thought and is what people accept as gospel, as Doc pointed out above, there are other things that can cut costs, and increase efficiencies. Insurance is a shell game, they want you to pay and not collect, and if you collect you get penalized, so as to increase their profits. It is always about profits, and there is never enough...that screws the whole thing up.

I had to switch to an HSA when Intel killed their Cadillac plan after ObamaCare, and the first year is the worst if something happens (which of course it did). Once you get enough in it to pay your deductable, it works ok, and you can fill it up for use in retirement. They are useful, but as I told Intel, they needed some way to cover the first year to make the transition. The three HR ladies I was being interviewed by were amazed at such a notion, and gave me a cash recognition...amazing...

Harmon, a good option if needed. If they repealed the whole mess, and let things like what Doc illustrates take over, it would probably work. I fear the looter mentality is too strong in DC though, to actually let go of such a goose....

Good points...

Look at Docs input above, there already are things in place that work. It's just none of them offer money to Republicrats and their masters.

Herb, again, you have to understand this is all about money, and buying influence and special setups to make money. The Republicrats just took the reins off the CEOs, and moved who would make the money off health care, not fix it. Even a lot of the peasants could figure that out, and were pissed off at them. The 2018 elections are either going to have a lot of 3rd party people or become a Dumbocrap rout of the Republicrats. Ryan is just so out of touch and loyal to his masters this cannot have a good end....

Doc, there you go, there are options, there are things that exist that have proven successful. However, the one they do not do: Pander to the people that support the politicians. The whole reason it would take so long to craft a bill is they have to check with their masters first. I don't think Trump fundamentally recognizes the rot in DC to the level he can effectively deal with it. He talks about it, but he does not understand it.

That would seem to be true, the repeal would be needed, since it has so many tentacles spread out, it is impossible to kill off except in one shot. Consider it a modern Hydra....

Plenty of other reforms can be considered and implemented without first repealing Obamacare. These include the ones I suggested: ending state and federal licensing of medical schools, hospitals, doctors and pharmacists; removing most of the power of the Food and Drug Administration; and enabling doctors and patients to freely contract on issues such as malpractice limits.

A couple hundred thousand would probably ruin my little paradise, making the biggest city (Spokane) even bigger. I love it out here where I'm at, about 30 minutes out of Spokane, in a different county, up a narrow and winding road, out in the sticks. We've got one new modern market with gas station, pizza place, sandwich shop, wine house, kind of western bar & grill, Mexican restaurant, a library, hair stylist (men and woman), dog groomer, small pharmacy, and our own gun shop that really caters to the ladies (run by ladies). And there is a permit on a door next to the wine shop saying that a Pot Shop will soon be moving in. I wonder if that will survive. I still hope we break away from Washington State West but doubt it will ever happen.

If you make more money, you pay more taxes. If you get really sick, you should pay more money for treatment, that's reality. Government rationale: you get really sick, make everyone else pay more...

Insurance companies dealt with risk management, and their premiums reflected that. Then came the (Un)Affordable Care Act which no one could afford. The healthy were penalized for being healthy, the sick for being sick; everybody suffered. The Freedom Caucus does not put forth a viable solution to resolve all of the problems. Government drove up the cost of health care so a $20.00 doctor's office visit years ago is now a $20.00 copay for the $365.00 covered by years of payroll deductions to retirement health benefits.

I bet there are at least a couple hundred thousand more people who would move to the state of Liberty if it is created. (Hopefully, not CA liberals;^)

Mark Levin described a "voucher" program where vouchers would be made available to the "poor" solely for the purpose of purchasing insurance. On its face, this seems like a good idea ... and would result in a market developing to cater to the "voucher" holders ... and a market for the balance of society.