Guaranteed health care for all, or just some?
This past week, the House of Representatives in Washington DC passed a bill to repeal the Affordable Care Act (ACA) and replace it with the American Health Care Act (AHCA). Afterward in the White House Rose Garden, a Republican orgy of self-congratulations took place where the President of the United States Donald Trump along with the Speaker of the House Paul Ryan celebrated the first dramatic step in altering health care delivery for all Americans.
Although the evolutionary process of this bill becoming a law will slow down considerably in the senate, the proposal thus far has been emotionally evoking to some, a refreshing wave of fiscal relief to others, and a perceived outright betrayal of the public trust to others.
Elected officials, effusive celebrities, concerned social activists groups, and senior organizations have stridently expressed their viewpoints regarding the suggested changes in the health care system.
The conspicuous question that is not being asked, except by the “Freedom Caucus” of the House, is why must any government intruded upon health plan be passed at all? If the ACA, otherwise known as Obamacare, was simply repealed and free market driven health care providers competed for the insured, would not the rates drop through competition? Those who are indigent or low income would return to hospital clinics and charity based facilities for primary care and would not be denied trauma care at emergency rooms. Because, under the long standing Hill-Burton Act they can not be turned away from care by law.
Although more than 20 million people were added to the health care insurance rolls as a result of the ACA, the result of the subsidization of lower income enrollees and the expansion of Medicaid was higher deductibles and more limited services at higher rates for small businesses buying policies through state exchanges. Also, the direct buying individual in the middle-class suffered the same inequity.
The ACA and the proposed AHCA are both defective in their own ponderous ways. Neither, have served or will serve the populous adequately and both are examples of redistribution of wealth plans.
There are two diametrically opposite poles of conducting health care in our nation, which are essentially feasible. One is socialized medicine or “Medicare for all.” The other is free market medicine. The difficulties seem to lie in the middle of the two extremes.
Seven years ago, a Democrat congress and a Democrat president passed the Affordable Care Act which for the first time in United States history made it compulsory to purchase health insurance or face punitive consequences. Where the goal of universal coverage might be considered laudable, the manner in which to achieve it was not. In then President Obama’s public relations campaign to garner support for what would eventually become the ACA, he famously and fraudulently promised “If you like your doctor, you can keep him” and “If you like your insurance you can keep it”. However, if your doctor was not a participating physician in whatever health care exchange you or your company was forced to purchase from, you could not keep seeing him or her. And if you health care provider did not participate in your assigned exchange, you needed to choose one that was. This inability to ensure a citizen’s individual liberty to make their own choices was the worst type of socialism. Simply, not only was one forced to comply, they were also forced to pay or face penalty.
Furthermore, most healthy young people opted to pay the penalty of a few hundred dollars per year rather than pay a few hundred a month for medical insurance. As a result, it was not profitable for participating insurers in the exchanges because they did not experience sufficient numbers of enrollees to defray the cost of the older insured or the indigent insured who were usually in poorer health. So, insurers withdrew from exchanges and now many are down to one or two overly costly choices. The Affordable Care Act proved to be fatally flawed and not so affordable with not such great care provided.
Currently, the Republican congress and the Republican president have proposed the repeal of the ACA and its replacement with the AHCA. This plan is also significantly flawed. The new plan may guarantee no one can be denied coverage for having a preexisting condition, yet it holds no restriction on rates. Thus, if you are a stage 3 cancer patient in need of insurance the insurer could require you pay for an assigned risk policy of a 250 thousand per year to gain coverage. Additionally in this plan, lower income direct purchasers of insurance would have to pay rate when purchasing the policy and look forward to a tax credit reimbursement when they filed their tax return. Since the average unsubsidized family health plan is current 10,200.00 per year according to the Insurance Institute, there is no way a family earning about thirty thousand a year could initially pay the $850 per month in the first place and still pay their rent. Consequently, the proposed tax credit is meaningless.
Also, under the AHCA, adults age 55 to 65 could be charged up to five times rate with no restriction on upward adjustments depending upon patient usage of their plan. The AARP, a senior activist organization, have condemned this facet of the plan as outright ageism and discrimination.
Furthermore, the AHCA rolls back who qualifies for Medicaid by eliminating the 138 percent of poverty level rule, transfers eligibility power more to the individual states, and will thus eliminate over 800 billion in federal funding for Medicaid over ten years. The money yielded from the cuts is intended to be allocated to provide tax breaks for the top ten percent of wage earners and to help replace the revenue lost in the proposed corporate tax cut.
Despite what we do know about the effects of an implemented AHCA, the newest version of the plan has not been scored by the non-partisan Congressional Budget Office. Which means that the 217 to 213 affirmative house vote on the bill was passed partially blinded by a lack of facts, and the effects of the plan could be more severe.
Across the political and pop culture spectrum, the reaction to the house vote was emotional. “Late Night” host Jimmy Kimmel, whose baby boy Billy was recently born a congenital heart condition that required surgery, went on a tear filled tirade. “If your baby is going to die, and it doesn’t have to, it shouldn’t matter how much money you make.”
Rhode Island’s liberal Democrat delegation expressed eruptive misgivings about the AHCA. Congressman David Cicciline was in a tizzy when he exclaimed it (the AHCA) is “the cruelest and most immoral thing I’ve seen the Republican Party do to the American people”; and that is a man who knows what immorality is folks. Senator Sheldon Whitehouse called the plan a “raw deal”. Congressman James Langevin expressed “It is unconscionable that House Republicans have forced through a bill in service of a purely partisan political goal at the expense of their constituents’ health.” And the more dignified and succinct Senator Jack Reed said “This bill is bad for public health.”
Virtually every medical organization including the Health Policy Institute, the Centers for Medicare and Medicaid Services, and the National Hospital Association, along with the AARP have said that 20 to 24 million people will lose their coverage as a result of this plan coming to fruition.
To sum up, the ACA and the AHCA are insufficient and defective in their own ways. The clear problems with both ideas are with the partisan government intervention itself. As a society we need to decide whether or not we are better served with a guaranteed basic health care as in Medicare for all financed by a national sales tax or a value added tax which would be universally paid without exception. Or, we have no program whatsoever other than senior Medicare and we let the free market of our capitalist democracy provide competition based options and hopefully lower costs.
Let us leave those combative, partisan, self-aggrandizing fools who supposedly represent us in Washington out of it. They will only screw it up as usual!