The main criticism of the Ryan Bill on "Repeal and Replace," coming from the Freedom Caucus, has to do with the tax credits that are designed to help lower and middle income Americans afford insurance. These credits replace the direct subsidies that were in Obamacare.
The Freedom Caucus argues that health insurance and health care costs will not decline if the Ryan Bill passes, because of the tax credits.
While it is true that the tax credits create more demand, than would otherwise be the case, there are other parts of Obamacare and of the American health care system that are probably far, far more important in determining insurance costs and health care costs. And, at the very least, the tax credits can be defended as suppportive of lower and middle income Americans and serving to even the playing field with current tax-favored employer plans. It is not a transfer to favored classes of people, which is a characteristic of a lot of existing health care as well as of Obamacare
Where to begin?
Obamacare requires all eligible health insurance sold to have certain coverages that apply to some buyers but not others. If buyers were free to choose the health insurance they would never, ever choose insurance that cover illnesses that they cannot possibly acquire. Almost every single Obamacare insurance plan does not fit the buyer. Thus folks are paying for something that they don't need.
Obamacare implicitly forbids the sale of health insurance across state lines. What conceivable reason could exist for this cost-increasing requirement.
Obamacare refused (in the Congressional admendment process) to consider limitations on frivolous lawsuits that drive up health care costs in two very important ways: 1) requires gargantuan medical mal-practice insurance premiums for doctors who, innocently, make mistakes (is there some busines that doesn't make innocent mistakes); 2) effectively forces doctors to peform unneccesary procedures, require unnecessary tests and, often, perform unnecessary surgeries -- for no other reason than to limit medical mal-practice lawsuits. A huge amount amount of these unnecessary items have no medical justification at all. They are a sop to the trial lawyer industry.
Obamacare extended Medicaid to 10 million recipients in the most inefficient possible manner. Ignoring the plain fact that currently one-third (and growing) of all physicians refuse medicaid patients, letting states designed the best system for their state -- which is in the Ryan bill -- can make medicaid dramatically better for recipients, as well as keep costs under control.
There are many other things about the current state of US health care and of Obamacare that will disappear eventually from HEW changes brought about by Secretary Price and further legislation that is already making its way through the House of Representatives.
The Freedom Caucus should swallow hard and accept the tax credits in the Ryan Bill and move on. They will never win this issue politically, but they could win all of the other issues outline in this post.