“Repeal Is A Fantasy. Reform Is The Task Ahead.”

David Frum wants the GOP to face reality:

Obamacare is a fact— a malfunctioning fact, like so much of the rest of the American healthcare system, yet a fact all the same. Its beneficiaries are rapidly coalescing into a vested interest, as the pharmaceutical companies and hospital insurance corporations and other providers are vested interests. Policy cannot realistically be made by dismissing such interests. They have gained something they will think is worth protecting. They will have the votes to protect it. If reform is needed, and it is, they will have to be offered something better.

Paul Howard and Yevgeniy Feyman recommend Republicans “make Obamacare a Trojan horse for conservative health-care reform”:

Based on data available for about 85 percent of exchange plans, about 77 percent have deductibles of more than $1,250 and qualify under Internal Revenue Service rules for a health savings account. For a 27-year-old purchasing coverage, the median HSA-eligible plan costs about $238 a month and typically comes with a deductible of about $3,600. The median plan without a high deductible, however, costs almost 30 percent more ($310) for a 27-year-old, though it has a significantly lower deductible (about $600).

Over the course of a year, the choice of an HSA plan can lead to significant savings. Here’s why: The typical 20-something with insurance spends a median of $770 annually on health care (excluding premiums and over-the-counter drugs). Opting for an HSA-eligible plan costing $238 a month ($2,856 a year), the median 20-something ends up spending $3,626 in one year on health care ($770 plus $2,856). However, with a traditional plan, total spending jumps to $4,320 in one year ($600 in out-of-pocket spending plus $3,720 in premiums). In other words, the HSA plan holder comes out about 20 percent ($694) ahead. That savings can then be funneled into an HSA or other spending.