The good side to the Trump-Ryan health care horror show
The extraordinary “American Health Care Act” passed narrowly by the GOP-led Congress without any public hearings Thursday does everything that health policy geeks like me know would jeopardize the health of millions — and dramatically boost the overall cost of health care for Americans. However, I want to thank the 217 Republican members of Congress and President Trump for revealing in a most dramatic fashion just how selfish, cruel and hypocritical they are.
There is no more cover.
Even if the Senate blocks passage of this nasty plan that literally takes away access to health care for women, men, children all over the country, 217 members of Congress are now on-the-record voting in favor of actual harm to millions of people and did so using the ugly, secret deal-making that they pledged to halt.
The legislation would do such things as:
- Allowing businesses to cherry-pick what services are included in health plans. This means that we would go back to the days when comparing offers from two different prospective employers means poring over the fine print of health plan paperwork. It also could mean that people have to choose between jobs based solely on health insurance — without any guarantee that the health plan offered today will still be there next year.
- Letting each state decide what constitutes “essential health services” for people who rely on Medicaid or Medicare. Need prenatal care so that you have a healthy baby? It will depend on where you live. What about physical therapy so that you might be able to avoid that hip surgery? Maybe. Mental health counseling? Probably should not even ask.
- Eliminating out-of-pocket caps, so that people with severe medical problems might face bankruptcy. This literally wipes out the “safety net” that Obamacare created.
Fundamentally, the proposals completely undercut Obamacare’s major success: leveling the playing field so that almost everyone had access to basic health care services and simplifying comparisons across multiple private or public plans.
The Trump-Ryan plan returns to what amounts to a free-for-all, controlled mostly by big employers and the insurance industry. It’s bad for people and bad for taxpayers, who ultimately will get stuck with the bills when people end up at emergency departments with major illnesses — and no insurance to pay for their care. And people will die because they avoid medical care when problems are most treatable. We know this because this is what happened before health care reform.
(For some data, below is an evaluation of the early years of Healthy San Francisco, a health care access and employer mandate that was implemented in 2007. One of the first measurable successes was a steady decline in non-emergency visits to the San Francisco General Hospital emergency department. Hospitals in other parts of California had increases both in ED visits and hospitalizations during the same period. Link below has more details.)
Even if you are not concerned about the specifics of the health care bill, there is another area that ought to generate major concern. The Republicans have now done precisely what they falsely accused President Obama of doing when the Affordable Care Act was passed.
When Congress took up what became Obamacare, they started with literally years of work done by members of both parties and engaged in more than 60 hours of debate, more than a dozen committee hearings, and plenty of time for people from all sectors to express their opinions. Did every member of Congress read the bill before voting? No. That’s a problem, but the process was not the back-room barter that occurred this week in Washington.
One only needs to look back on House Speaker Ryan’s own words to see the problem here.
“Before members even had time to read the 1,000-page bill, it already has cleared two major House committees and is set to be fast-tracked through Congress in the days and weeks ahead. Those members of Congress who voted for this bill already in their committees did so without knowing what the legislation costs. Before it’s too late, let’s take a closer look.” — Rep. Paul Ryan in a 2009 Milwaukee Journal-Sentinel op-ed.
If the Republican Party truly was the bastion of ethics and transparency that both President Trump and Congressional leaders claim, this simply would not happen.
However, it happened. Now it’s up to everyone who disagrees to vote hypocrits out of office in 2018.
