In 2008, Drs. Mark Albanese, George Mejicano, and Larry Gruppen, concerned about "a looming shortage of physicians" wrote about the "four horsemen of the medical education apocalypse" which include

Should the Senate Republican health care reform legislation pass, it will usher in another house of horrors just like Obama's patently not affordable health care law.

teaching patient shortages, teacher shortages, conflicting systems, and financial problems. Rapidly expanding class sizes and new medical schools are coming online as medical student access to teaching patients is becoming increasingly difficult because of the decreasing length and increasing intensity of hospital stays, concerns about patient safety, patients who are stressed for time, teaching physician shortages and needs for increasing productivity from those who remain [.] Further, medical education is facing reductions in funding from all sources, just as it is mounting its first major expansion in 40 years. The authors contend that medical education is on the verge of crisis and that little outside assistance is forthcoming.

Indeed, the GOP bill will bring us even closer to another crisis.

Should the Senate GOP "repeal" bill pass, it will result in as Matthew Vadum illustrates "tinkering around the edges of the Obamacare system but leav[ing] the fundamentals of the failing program in place."

With only four courageous conservatives who have come out "against the language in the new draft bill" the American people must, yet again, rise up and demand a true repeal and replace bill. Sens. Mike Lee of Utah, Ted Cruz of Texas, Rand Paul of Kentucky, and Ron Johnson of Wisconsin are the only ones holding back the onslaught of what will eventually be a single-payer system in this country.

If Jonathan Gruber said that the Senate document is "no longer an Obamacare repeal bill [and] that's good" that should be more than sufficient evidence that this bill is not going to help Americans. Gruber, dubbed the "Obamacare architect was caught on tape admitting that Obamacare doesn’t provide subsidies for federally-run insurance exchanges [.]" In another video "Gruber said that 'the stupidity of the American voter' made it important for him and Democrats to hide Obamacare’s true costs from the public. 'That was really, really critical for the thing to pass,' said Gruber. 'But I’d rather have this law than not.' In other words, the ends -- imposing Obamacare upon the public -- justified the means."

Most Americans now understand that "Obamacare really is a huge redistribution of wealth from the young and healthy to the old and unhealthy" and Daniel Horowitz at Conservative Review explains that "everything [in the Senate bill] is working within the confines of the most extreme socialist baseline from the Obama era." Horowitz gets to the nub of the problem when he writes that to "avoid the endless semantics, lies, and perfidious distortions from GOP leadership on how they are 'repealing' Obamacare, let’s briefly describe the law."

Obamacare comprises five core elements related to health insurance (putting aside the burdens on health care itself): actuarially insolvent regulations; open-ended, means-tested subsidies; Medicaid expansion; the employer and individual mandates; and the tax increases. Regulations: The foundation of Obamacare are the two dozen or so actuarially insolvent regulations designed to 'cover everyone' but that in turn have tripled premiums and are now destroying the entire individual market. Subsidies: Because the regulations make insurance unaffordable, anyone below a certain income level is subsidized to purchase medical insurance. This, in turn, inflates the cost of insurance even more. Medicaid expansion: In addition to subsidizing non-Medicaid patients to purchase unaffordable medical insurance (thanks to the regs), Obamacare dramatically expanded both the eligibility and the federal subsidy rate to the states for the program. The cost of covering an individual in the subpar Medicaid program was $3,247 per individual in 2011 before Obamacare was enacted. In 2015, according to data from the Department of Health and Human Services, the cost of enrolling an individual in Medicaid doubled, to $6,366 per individual. And that is only for the second year of implementation. The funding mechanism of tax increases: In an attempt to make the government spending and the regulated private sector solvent, Obamacare levied over $1 trillion in tax hikes (over 10 years). Also, in order to ensure that younger individuals don’t game out the system by not purchasing insurance but then taking advantage of the new regulations forcing insurers to provide for those who already got sick, Obamacare enacted the individual mandate to force everyone to purchase insurance up front. It also forced all employers of large businesses to provide insurance plans so that more money would flow into the system. However, the regulations have been so insolvent that these mandates proved insufficient to fund the Ponzi scheme.

Horowitz asserts that the "Senate bill is essentially a more liberal version of the House bill, which, in itself, was a more insolvent version of Obamacare [.]" Thus, the market is not healed, "competition is not restored, and prices don't come down." Ergo, "nobody will be able to afford insurance, and everyone will need subsidies or Medicaid." In essence, "the GOP bill replaces Obamacare subsidies... with more subsidies."

In 2013 Sally Pipes wrote that "thanks to Obamacare a 20,000 doctor shortage is set to quintuple."

America is suffering from a doctor shortage. An influx of millions of new patients into the healthcare system will only exacerbate that shortage -- driving up the demand for care without doing anything about its supply. Those who get their coverage through Medicaid or the exchanges may feel the effects of the shortage even more acutely, as many providers are opting not to accept their insurance. Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. The shortage could quintuple over the next decade, thanks to the aging of the American population -- and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50. Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found that 60 percent of doctors would retire today if they could, up from 45 percent before the law passed. Doctors are also becoming choosier about whom they’ll see. They’ve long limited the number of Medicaid patients they’ll treat, thanks to the program’s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients. Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.

As Pipes asserts, "[t]he first step in addressing America’s shortage of doctors is full repeal of Obamacare. And the second is the installation of market-based reforms in its place. That’s the best way to ensure that Americans can actually get care when they need it."

The Four Horsemen of the Apocalypse generally refer to the tribulations that will befall mankind. How wonderful it would be if the four congressmen who see through the myth-making of the GOP "repeal" plan would actually be victorious, for then the American people will reap the rewards and the devastating government overreach will be diminished. If the subsidies remain, that will "further distort the market and... in fact, after 2020 the subsidies are made even worse and go into the middle class."

Thus, the system will be completely insolvent and this time "the Republicans will actually own it."

Eileen can be reached at middlemarch18@gmail.com