The Healthcare Debacle
I understand why some people do not like the ACA; there are hardworking individuals out there who are struggling financially, but still earn too much to receive federal health care subsidies. I can certainly empathize with the frustration they must feel when they see their tax dollars go towards healthcare for the most disadvantaged sector of the population— healthcare that they, themselves, cannot afford.
Rather than attempting to actually alleviate the working class’s frustrations by making healthcare more affordable for them, the Republican Party thought they could satisfy their base by simply cutting Medicaid and thereby taking healthcare away from the poor. That way the score was even again; neither the poor nor the working class could afford health insurance. To add insult to injury, rather than directing all the savings from the massive medicaid cuts towards reducing the deficit; Congressional Republicans decided to give a portion back to the wealthiest Americans, in the form of tax cuts. None of their proposals included credible ideas on how to lower premiums. All they had to offer were recycled, debunked notions of trickle-down economics and the unrealistic applications of free-market theory to health care. In fact, their plans would have increased premiums for many — especially the elderly and the sickest people in this country, and one plan would have made healthcare completely unaffordable for those with pre-existing conditions (the one with the Cruz amendment). I can’t imagine that that was what Trump supporters had in mind, particularly since Trump specifically promised not to cut Medicaid and Medicare during his campaign.
Republicans generally support their desire to cut Medicaid and Medicare by pointing out that since an increasing input of funds is needed year after year to keep these programs running, they are simply not sustainable. Using that logic, isn’t the military also unsustainable? And yet, I’ve never heard members of the Republican Party use that as a reason for not pumping more money into the military, even though the military plays no more crucial a role in protecting the lives of the American people as having health care.
But, what ultimately turned out to be a complete failure of this Republican Congress to make any progress towards fixing healthcare in this country, also served to underscore the fact that their rhetoric over the last seven years has been nothing more than a political stunt. By engaging in over 50 meaningless repeals of the bill, the House of Representatives not only wasted everyone’s time, but also conned the American public into thinking that a simple repeal of the ACA would fix the problem. The reality is that they had no idea how to fix our health care system in any meaningful way — certainly not when they had to find a way to satisfy not only the right wing and libertarian wing of their party, but also the moderates. Passing any sort of bill ended up being impossible.
I have been accusing the Republicans of being self-serving and dishonest about their actual intent for over a decade. Before the Trump era, Republicans always insisted judgments of that sort were unfair and purely partisan. But, after witnessing the congressional Republicans provide public support for Trump over and over again, even when they knew full well that Trump is putting the nation’s safety and democracy at risk, it’s difficult for any reasonable thinking person not to see the Republican Party as anything but self-serving and dishonest! This healthcare debacle put the last nail in that coffin!
The Democrats, on the other hand, do have ideas about how to solve the problems with the ACA, ideas that will help the working class, without taking healthcare away from the millions of others who benefitted greatly from the ACA. To start, the Democrats would allocate additional federal dollars to subsidize more working class Americans. (The funds could perhaps come from some of those billions already allocated towards increasing our military arsenal — for no reason other than to appear stronger). They would also do whatever they could to stabilize the insurance system as a whole (that would include finding ways to maintain a certain participation level and addressing high drug costs). With stability, the insurance companies would no longer need to pull out of the system (many would return), and they could stop raising premiums to unaffordable levels as a means of offsetting uncertainty in the marketplaces. (Of course, that is a very simplistic description of a very complicated issue.) Actually, what the Democrats would really like to do (though they could only do it if they had the control of both chambers of Congress) is install a public option into the system so that the private insurance companies would have to compete for customers with the government. That’s the best way to force down prices.
Because the media coverage on the right paints such a dreadful picture of the present state of the ACA, many people do not realize that only 3% of the population has been affected by the high premium increases that are so often mentioned. https://www.nytimes.com/interactive/2017/03/09/us/politics/who-is-really-affected-by-rising-obamacare-premiums.html?_r=0 That’s because 85% of the people in the marketplace receive federal subsidies which generally shield them from those increases. It’s also because a majority of Americans get insurance from their jobs and the government, and thus have not been directly affected by the ACA. In fact, in recent years, the growth rate of their premiums has been lower than the pre-ACA growth rates. Of course, none of this means that the suffering of the 3% isn’t an important issue that must be addressed.
Another complaint about the ACA is the mandate. Young people especially do not like to be forced to buy healthcare; after all, the likelihood that they will face a health emergency is low. But once the Democrats sat down to craft their healthcare bill, it became clear to them that you could not address the issue of pre-existing conditions without having a mandate.
What people tend to forget, though, is that the mandate was originally a Republican idea from the Heritage Foundation. This idea of including a mandate to buy health care was a direct response to the decision we all made as members of a civilized society, that if an uninsured person is, for example, seriously hurt in a car accident, they will not be left on the street to die just because they are uninsured. That way, instead of having those who are responsibly insured pay for emergency medical treatment for the uninsured (insured individuals ultimately foot the bill for the expensive emergency room visits of the uninsured), everyone would contribute. The mandate is based on the notion of “personal responsibility,” a principle generally cherished by conservatives.
There are sensible ways to make the ACA work better for that 3% who have definitely loss out, without sacrificing the health of millions of other Americans in the process. But that can only happen if those on the right are able to come to terms with the fact that the introduction of the ACA seven years ago — even with all its flaws, has pushed the majority of the country away from viewing healthcare as a privilege and instead towards seeing it as a right. That means more Americans than not want their government to play a role in making healthcare affordable for them. The Republicans have been peddling the idea that maximum choice was what mattered most to Americans when it comes to healthcare; that sounds great until you realize that getting more choice was at the expense of affordability. If you can’t afford any healthcare at all, what difference does it make if you have many options to choose from?
