The conservative TV pontiffs and their print counterparts, including The Wall Journal editorial page, are saying all hail the free market alternative to the Democrats government takeover of our uniquely American healthcare system. The Republicans are eager to admit that the current system is broken, but reform should not destroy it. After all, for those that can afford it or get unlimited care from the government or their employers, the care is the best in the world.

Republican Congressman Paul Ryan’s “Patients' Choice Act” is a thinly masked rehash of "McCain Healthcare: An Evil Play on Words". Both the Ryan and Senator McCain plans depend on the states, out of the goodness of their hearts, to provide “guaranteed access.” Neither plan actually forces private insurance companies to eliminate medical underwriting, nor provides for enforceable state high risk pools or for a government plan to insure the people a private insurer rejects.

Ryan’s “Patients' Choice Act Q&As” helps us dissect the illusion of guaranteed access. Guaranteed access was never intended to be confused with or imply guaranteed issue. First, consistent with McCain, Ryan would move the tax advantage from employers to employees and individuals. Next, the same type of voluntary insurance exchanges would be regulated at the state level, as would any high risk pools. Each state would act as a laboratory of innovation in cost control and adverse risk redistribution amongst private carriers.

Individuals would be guaranteed access to any plan in their state’s exchange. Any plan licensed in their state is eligible to join their state’s exchange as long as it meets minimum federal standards. Each state has the freedom to establish a high risk pool or develop any other means to fairly redistribute or reinsure the risk between the exchange’s plans. But nothing is actually required along the lines of community rating, or eliminating any form medical underwriting in determining premiums.