Here's an idea for this election season: No politician can bash any aspect of the health care law that President Barack Obama signed in 2010 without proposing a better solution.
Who'll take that pledge?
Let's start with lawmakers who groused last week in Frankfort about Gov. Steve Beshear's executive order establishing a health insurance purchasing exchange.
What are they offering the 1 in 5 working-age Kentuckians who have no health insurance?
We got a Republican campaign preview when Sen. Bob Leeper, an independent who usually votes with the GOP, said he was reluctant to put his name on anything related to "Obamacare."
Okay, so, what would he tell a sick Kentuckian whose job provides no health plan, who can't afford insurance and does not qualify for Medicaid? That she's better off putting her photo on jars beside cash registers and begging for quarters than receiving treatment under that nasty ol' "Obamacare?"
What of Kentuckians who scrimp and save to buy health coverage only to learn that when they really need it the fine print says no? Why is being bankrupted by an illness better than "Obamacare?"
Let's hear the Republican plan for creating a transparent, competitive individual health insurance market, in which 80 percent of consumers' premiums have to go to health care, not executive salaries or other overhead.
Sorry, that's a trick question; the Republican plan for reforming the health insurance market is "Obamacare." A Democratic Congress and president enacted a plan that had been conceived and supported by Republicans.
"Obamacare" bends over backwards to avoid disrupting the status quo, while coming close to achieving universal health care. The Congressional Budget Office says it will reduce the federal deficit by $130 billion over the first decade and $1.2 trillion over the next decade.
Nonetheless, Republicans and some Democrats insist we can't afford "Obamacare." They should explain how we can afford to keep doing what we've been doing, which is paying to care for almost 700,000 uninsured Kentuckians — when it's too late, in the emergency room, when it's most expensive.
Kentucky's economy is dragged down by its sick populace. A litany of statistics cries for more and better preventive care. The Affordable Care Act won't solve all that overnight, but it gets us moving in the right direction.
The insurance exchange, which the federal government will run if Kentucky does not, will enable comparison shopping for policies and subsidies and tax credits for individuals and small businesses to afford health insurance. Individuals who still can't afford coverage will qualify for Medicaid.
Kentucky stands to gain more than any state from the Medicaid expansion, says the Kaiser Commission on Medicaid and the Uninsured, because such a large proportion of Kentuckians are working for wages that barely lift them out of poverty.
The federal government will initially fund the Medicaid expansion; eventually Kentucky will have to pay 10 percent of the new cost.
Politicians who don't like that deal should explain how they would do better.