As a follow up to my previous essay on Republican gross ineptitude in offering an alternative comprehensive health care plan to Obamacare, today I’d like to discuss the highlights of a plan being offered by Rep. Mark Sanford. You may remember Mark Sanford as the married Republican Governor of South Carolina who went, ostensibly, for a 6 day hike along the Appalachian Trail and was found in Argentina with his mistress. It’s so easy to get lost on that Appalachian Trail.

Rep. Sanford discussed the advantages of his plan in an editorial for South Carolina newspapers filled with generalizations, half-truths, and obfuscation. Let’s look at some of his editorial.

“Our plan is built around free market principles . . . necessary to better care, access, and health care pricing.”

There is a universally accepted truth that the US health care market does not function or behave as a free market. A basic principle of the free market system is that the buyer and seller are each armed with full information and come together in a voluntary transaction. In health care, the buyer is at an informational disadvantage at every turn of the transaction – diagnosis, therapy options, and pricing. There is no level playing field. Also the overall market, and every individual transaction, is dominated by the presence of “third party payers” such as BC/BS, insurance companies, and Medicare. Paul Krugman, Nobel Prize winning economist, advises, “There are no examples of successful health care based on free market principles, for one simple reason: in health care, the free market just doesn’t work.”

“Our plan legalizes less expensive health insurance. . . Obamacare minimum coverage mandates meant that each of us has to have a plan that has what the government deems essential”

These cheap plans are awful. They aren’t insurance. After the ACA was passed, no one was sorry to see these plans go away. These plans offered little or no catastrophic coverage, have huge deductibles, and are riddled with limitations and exceptions. Sellers of these plans have preyed on the poor, uninformed, and desperate for decades. These “cheap” plans should never see the light of day in the US again.

“We strengthen individual health savings accounts (HSAs) – our plan gives a non-refundable tax credit of up to $5000 per year”

Republicans are going to use sleight-of-hand to confuse people about HSAs and insurance throughout this debate. Make no mistake – HSAs are not a substitute for any aspect of health insurance. The original idea behind HSAs was to supplement insurance by providing people with a tax free fund to cover deductibles, out-of-pocket expenses, and elective procedures, such as LASIK and plastic surgery. HSAs were aimed at the upper middle class and above. No matter what you hear from Republican leadership, HSAs are not health insurance and are not a substitute for any aspect of the ACA.

“We allow for pre-existing conditions. So, in our plan, as long as you buy insurance and stay on it, they cannot kick you off (if you get a disease). Obamacare did the opposite. It incentivized people to wait to get sick to get insurance.”

Where do I even begin with this paragraph? Either Sanford doesn’t understand the meaning of these terms and what Obamacare required (very possible) or he is just lying and trying to deceive the uninformed voters. I don’t even know what the phrase “allow for pre-existing conditions” means. Neither, obviously, does he. Sanford discusses how, under this plan, if you are on insurance and get a disease, you cannot be dropped. Of course not. No health insurance plan licensed by the 50 states over the last 60 years has been allowed to drop participants if they get sick while on the plan. This is illegal. More importantly, becoming ill while on a plan is not a “pre-existing condition”.

Let’s be clear here. A “pre-existing condition” is a health infirmity that is diagnosed and known to the person prior to changing a plan or initiating new coverage. The government will not be able to mandate that insurance companies insure all people with pre-existing conditions unless they are able to guarantee that the insurance “pool” will primarily be composed of healthy individuals. There is no way around that assurance. The ACA guaranteed a heathy “pool” by mandating that all people were required to purchase health insurance or pay a penalty. Without this requirement, no insurance companies would participate in the program. Sanford’s editorial blatantly lies when he claims that “Obamacare incentivizes people to wait until they get sick”. Obamacare actually did just the opposite. People had to sign up for health insurance by certain deadlines regardless of health status or face a fine. If Republican plans do not guarantee a healthy “pool”, insurance companies will not cover pre-existing conditions. It is as simple as that. Republicans won’t be able to fool the voters by calling “in-plan illnesses” by the name of pre-existing conditions.

Based on his own editorial, Sanford’s plan contains no elements of extensive health coverage for the 22 million people covered by Obamacare. I believe the public will be inundated with these half-baked plans for ACA replacements over the next 6 months. And a doozy will be coming forth from the White House sometime soon. Examine them carefully. The health market of the US is extremely complicated and certainly in need of help – simple men with quick fixes need not apply.