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White Paper: After the Affordable Care Act: Freedom for All vs. Medicare for All

April 5, 2019

This paper is about alternatives to the Affordable Care Act.

stethoscope and insurance docs

The Trump Administration has announced that it will not defend the constitutionality of the Affordable Care Act. Democrats seem dedicated either to preserving and expanding ACA, or to proceeding to a complete government take over—Medicare for All.

 What other choices might there be?

 The Association of American Physicians and Surgeons (AAPS) suggests freedom, instead of trying to force everyone into one model: “If you like your ObamaCare, you can keep your ObamaCare. If you like your Medicare, you can keep your Medicare. But if you don’t like it, you have a choice.” AAPS observes that:

  • Medicare and ACA are both unaffordable and unsustainable.
  • Medicare abolishes alternative insurance for seniors, ACA virtually wiped out non-ACA compliant plans, and Medicare for All proposals would outlaw private insurance altogether.
  • Medicare, ACA, and federal tax policy created the problem of pre-existings, which are uninsurable risks, by driving out plans that offered subscriber-owned (vs. employer-provided), guaranteed-renewable coverage.
  • Comprehensive insurance (which generally means managed care) is not the only way to pay medical bills—just the most expensive way, fraught with moral hazard and inevitably leading to scarcity and rationing.


 AAPS advocates removing restrictions that prevent Americans from developing a thriving, innovative private sphere that can optimize cost, quality, and availability, based on individual choice rather than central planning.

Jane M. Orient, M.D. is executive director of the Association of American Physicians and Surgeons and president of Doctors for Disaster Preparedness. @jorient