When It Comes To Healthcare Republicans Have A Strange Definition For “Freedom”

“Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.”
Paul Ryan while introducing his ACA replacement

If you want to understand the logic behind Republican proposals to replace Obamacare, always start with this question? How will this proposal impact the health insurance companies?

Scratch beneath the surface of any healthcare discussion and you will find that Republicans are usually talking and thinking in terms of a product — health insurance. And their proposals are meant to benefit the industry that supplies that product.

But individual citizens are usually thinking in terms of a need — healthcare services.

When Speaker Ryan talks about the freedom to “buy what you want to fit what you need”, he is referring to that moment when you are signing up for your policy. He is treating the purchase of health insurance as if it were like any other product you may choose to buy.

Conservatives are fond of comparing health insurance to televisions, vacations and all sorts of commodities and widgets. And the reality is that the “health care is a product” frame has won out over the “health care is a human right” frame long ago.

If you accept their point of view that, “health insurance is like any other product or service on the market”, Ryan’s comments about freedom make sense.

If you want the finest television on the market you can save up for it and buy when you have earned it. But you also have the freedom-of-choice to buy the smallest, most basic model right now. If that is what you decide you need.

At the time of purchase, “need” for most insurance buyers means, “I need to buy something as cheaply as possible”. Buying insurance based on budget makes sense only if you view health insurance as an end unto itself. As if having a policy with your name on it is what matters.

But the point of having health insurance is so that when you need health care you have insurance that covers those needs.

Buying inadequate coverage because that is all you can afford is understandable if you are a cash strapped consumer. But a government policy that encourages — even celebrates — that sort of short term thinking is indefensible.

Paul Ryan Loves All-Policy No-Coverage Health Care

If the Republicans do pass a health care bill it will definitely not include an individual mandate. And that is consistent with the Paul Ryan quote above. You will be free to choose not to buy health insurance. (And if you get sick or injured the taxpayers will be on the hook to pay for the minimal care you get.)

And any bill the Freedom Caucus supports will not include the 10 Essential Health Benefits(EHBs) that must be included in any insurance policy as long as Obamacare is in place. Coverage for health services like emergency room care, hospital stays, laboratory tests, prescription drugs and more are mandated under our current law.

To put it in Ryan’s terms: you will be free to lower your monthly premiums by deciding you don’t need coverage for any of these services. Which is good news if all you care about is lowering your monthly premiums as much as possible. But if you do get sick or injured and need emergency room care or an extended hospital stay you will be in the same boat as the uninsured. Even though you have been paying your monthly premiums all along.

Is this really the sort of cat and mouse game we want to play with our healthcare system?

Conservatives know this is such a bad idea that the way they are going about eliminating the 10 EHBs is intentionally confusing. The most recent proposal keeps the 10 EHBs but allows states to opt-out if the state can show that this step will reduce “average premiums for health insurance coverage in the state.” All a state has to do to opt-out is submit an application to the feds and wait 60 days.

This opt-out ploy allows Republicans to claim they did not do away with the 10 Essential Health Benefits. But that will be the effect.

When insurance companies can once again offer low cost policies that don’t cover emergency room and hospital stays, people will certainly have more freedom of choice.

People will be free to choose a lower premium today in exchange for little to no coverage later.

And insurers will be free to collect premiums month after month, year after year, from millions of budget conscious Americans. All while never being at risk of having to pay out big money to cover major health services like those included in the 10 EHBs. Again, that risk will fall to the taxpayers. Just like in the good ole days.