Republicans in Washington are doing their best to limit the federal government’s responsibility for the nation’s health care needs, placing as much of the cost and the decision-making on the shoulders of those who need it. If only that were possible. For most, those decisions are too complex and the costs too large.

Health care consumes approximately 17 percent of the country’s gross domestic product, and is growing. A third of the cost of insurance is in administrative fees, and a third of what is prescribed is unnecessary. What is spent on marketing drugs exceeds research costs. Extraordinarily specialized care is available to some, while emergency room care, uncompensated without insurance, is the fallback.

With insurance, those emergency room issues in many cases could have been dealt with earlier and at less cost.

And the system is based on fees for services, not on the health of an individual.

Public employers and large companies have teams of specialists to negotiate the best deals with insurance companies and providers, small businesses do not. Those individuals who pay cash pay the most of all.

Delegating health insurance and medical care responsibilities to the states, a part of the American Health Care Act of 2017, fools no one. States are required to have balanced budgets, and the amounts needed rival the biggest line item, funding public schools.

The health care required for a productive workplace, to spare other health and human service organizations their involvement, for relationships which do not burden family members – the states are not the place to look to fund health care.

An ocean liner comes to mind in what the Republican members of the Senate have done to the House legislation behind closed doors: Offer a little more tax credit premium assistance based on need for those in the years leading up to Medicare, and delay the halt of Medicaid expansion funding for a few more years. And, perhaps create a fund aimed at the opioid crisis. It is not nearly enough.

The results are predicted to be about 22 million without insurance in a few years, a return to pre-Obamacare numbers of those without Medicaid, uncertain coverage of pre-existing conditions, and higher premiums and deductibles for those who are pre-Medicare. Not a future which benefits those millions of individuals, nor the country.

To get health care right, with policies that can endure for at least a decade, to provide the predictability which the insurance and health care industries require and citizens deserve, requires the involvement of both political parties. Most of all, it requires the Republicans to be far more accepting of a major federal role in the solutions.

A healthy America means stronger workplaces and fewer demands on other public agencies and assets, providing a real return on tax dollars.

The challenge, in the interests of both parties, will be to bring down the cost of health care and thus insurance, and to make the solutions operate as efficiently as possible, as Medicare does.

Legislators would be wise to spend the remainder of 2017 shaping the future of health insurance and care for all Americans for the next decade.