Would the Republican “Repeal and Replace” Bill Improve Obamacare?​

by G. Keith Smith, M.D.           

The policy experts can’t seem to agree on whether Graham-Cassidycare, the latest Republican effort labeled “repeal and replace,” is an improvement over Obamacare. I would argue that all of the wonk-discussion is downstream of the false premise that government can meddle in and distort health markets in a beneficial way. Historically when government intrudes into anyone’s business it is always to benefit its crony pals, however veiled these efforts might be.

This new legislation is all about “coverage” and is designed to streamline the flow of taxpayer loot to the big insurance companies after skimming off a share for the bureaucracy. I would encourage everyone to stay focused on the real issue: the cost of medical care, which is (not surprisingly) not addressed in D.C.’s latest belch of central planning. As Dr. Yuri Maltsev (Austrian economist and former Gorbachev cabinet member) recently told an Oklahoma City audience, quoting Gorbachev: “It’s not that central planning doesn’t work. It’s just that we haven’t found a plan that works.”

It is high time that everyone acknowledge that it is impossible for D.C. operatives to represent the source of a solution, as they are and can only be the source of problems. If the good folks in D.C. truly want to help, they should place their crony health engine in reverse, and undo the years of distorting and price-increasing damage inflicted on Americans.

While Bernie Sanders and his fellow Marxists loudly profess that we are suffering from the failure of the free market in medical care delivery, I would argue that we are suffering from the absence of free markets. This crisis, created in D.C., is one from which industry insiders (connected to both sides of the aisle) have obscenely profited, as only a cartel (not a competitor in a free market) can.

The mutually beneficial exchange that forms the essence of free markets and capitalism depends on a seller of goods and services responding to the needs and preferences of buyers in the marketplace, without intermediaries, except for those who facilitate this exchange. D.C.’s mandates and subsequent insertion of crony intermediaries between willing buyers and sellers has blurred or destroyed the competitive market discipline that tends to simultaneously lower prices and increase quality. Graham-Cassidycare just distorts natural buyer preferences in a slightly different direction, one which primarily favors those behind the curtain who wrote this bill.

In spite of D.C.’s efforts, free-market delivery of medical services, once confined to plastic and Lasik surgery, is fortunately a growing trend, as fewer individuals and companies buy the scam referred to as “health insurance.” Individuals are increasingly forgoing “insurance” altogether or are participating in the cooperatives known as “cost sharing ministries.” Employers in astonishing numbers are embracing “self-funding,” preferring to pay for their employees’ medical needs from operational revenue rather than participating in the “health insurance” swindle. These buyers have the appropriate sticker shock that price-gouging medical facilities regularly generate and are increasingly patronizing competitive and price-transparent medical facilities.

For example, beneficiaries of the self-funded health plan of the State of Oklahoma pay nothing out of pocket if they elect to have their surgery at my facility (or another that will match our online, bundled pricing), an arrangement that will reportedly save the State of Oklahoma up to $200 million per year. This cost competition benefits everyone, as the availability of this pricing knowledge empowers all consumers who are shopping, even those far from Oklahoma.

While various “insurance” tweeks may render slight benefits here and there, nothing will more powerfully improve the lot of the American seeking high quality and affordable medical care than a free and competitive market, where the sellers cater to the buyers, a condition every other industry must endure. Also consider this. In Canada, tax victims send their hard-earned wages to Ottowa, which bureaucratically distributes a portion to the various provinces. This bears an uncomfortable resemblance to Graham-Cassidycare, and in my opinion, represents a dangerous leap toward the insanely dysfunctional system the Canadians endure.

“Repeal and replace” has become “If you like your Obamacare you can keep it.” I prefer “Repeal and acknowledge,” a strategy that admits that the fatal conceit of central planning applied to medical care is an expensive, dangerous, and deadly mistake.


Anesthesiologist Dr. G. Keith Smith serves as the medical director, CEO and managing partner of a “free market” outpatient surgery center in Oklahoma City, while also maintaining an active private practice.

Dr. G. Keith Smith is the co-founder of the Surgery Center of Oklahoma, one of the few medical facilities in America that openly posts the prices of its surgeries on its website. The fee-for-service medical facility is devoted to delivering top-rate care at a fraction of what conventional hospitals charge.

When Dr. G. Keith Smith launched the first website displaying all-inclusive pricing for various surgical procedures in 2009 it attracted national and even international attention for him and the Oklahoma medical treatment facility, which is owned and operated by around forty of the top physicians and surgeons in central Oklahoma.

Since then, many Canadians and uninsured Americans have taken full advantage of the low and transparent pricing available at the surgical treatment center.

The operation of this free market medical practice, arguably the only one of its kind in the U.S., has also garnered the endorsement of policymakers and legislators across the nation.

The Surgery Center of Oklahoma’s consumer-driven model could well become increasingly more common as Americans look for alternatives to the traditional health care market in the face of higher costs and reduced access to doctors and hospitals under the Affordable Care Act.

Dr. Keith Smith, co-founder of the Surgery Center of Oklahoma, explained to Bill O’Reilly (The O’Reilly Factor) how patients across North America have grown increasingly tired of waiting in line for prohibitively expensive medical treatment and will naturally gravitate towards lower-cost, higher-quality medical care available from physicians and facilities outside of ObamaCare.

Self-funded insurance plans are already taking advantage of Dr. Keith Smith’s medical services pricing model in greater numbers, resulting in significant savings to their employee health plans.

Dr. Keith Smith believes that the healthcare system is perversely designed to keep Americans paying higher and higher prices while subsidizing huge corporate-controlled hospitals with tax dollars obtained through their fictional not-for-profit status.

Dr. Keith Smith took the opportunity to discuss with John Stossel just how these “non-profit” hospitals and insurance companies drive up the cost of care by practicing dishonesty in pricing.

Dr. G. Keith Smith hopes that as many medical treatment facilities as possible adopt a similar transparent pricing model, a move he believes will lower healthcare costs for all and improve quality of patient care.

To encourage widespread adoption of his proven methods amongst the medical profession, Dr. G. Keith Smith co-founded the Free Market Medical Association so as to revolutionize managed medical care through treatment cost transparency.