Once the elections are over momentous decisions will need to be made regarding our health care system.  The prevailing law is the Affordable Care Act, which has got to either be fixed, or repealed and replaced. Any fix would eventually take us to a single-payer, national system.

Phil Gramm was a 3-term United States senator from Texas. He served 14 years on the Senate Budget Committee and chaired the Senate Banking Committee.

His recent opinion piece in the Wall Street Journal describes an earlier attempt to pass a national health care system. He knows what he’s talking about. He helped lead the opposition to the 1993 Health Security Act. Senator Gramm describes that proposal as “a comprehensive plan for the government to take over the health care system, with program details and cost-control measures precisely defined.”

Since then-first lady Hillary Clinton was tasked by her husband to spearhead the effort, it became known as HillaryCare.

The legislation would have set up regional Healthcare Purchasing Cooperatives. These co-ops would agree on treatment guidelines and implement cost control measures. Everyone would be required to pay into them. Providing treatment outside what was determined permissible by the regional cooperative would bring civil penalties. Accepting a separate payment for such care would bring criminal penalties. Doctors desiring to provide care not covered within the system would be forced to operate completely outside it.

The bill never became law. It stalled in the Senate.

Fast forward 18 years. The Affordable Care Act was not nearly so precise. Senator Gramm writes; “the Obama administration left as many details as possible to be written during implementation, after ObamaCare became law.”

Back in 1993, Senator Gramm teamed up with Senator John McCain and Senator Paul Coverdell to oppose the Health Security Act. They informed the American public and members of Congress of the ways in which the plan was inefficient, and unaffordable. Senator Gramm says that those arguments did not resonate. What sunk it, he says, was the “extraordinary loss of freedom” entailed in the law. In his column, the senator reminds us that what really killed this bill was its plan for a “National Control Board which would have determined every allowable benefit and treatment. The board’s decisions were to be “final — not reviewable by any agency or judge.”

The 1993 Health Security Act would have immediately closed down the market for individual and small group health insurance. The Affordable Care Act did not do this. The original understanding was that people would be able to keep their health insurance if they wanted to. But the law’s implementation is making that impossible with skyrocketing premiums and massive losses forcing insurance companies out of its markets.

So — the next Congress will have to decide: repeal the ACA and bring in a free health care market or nationalize the system and cause the loss of freedom that was considered unacceptable in 1993.