Coverage vs. Cost- Obamacare and Trumpcare a Values Battle

When the CBO scoring came out on the American Health Care Act, or Trumpcare, the headline was damning- 24 million people would lose their health insurance over the next decade. Republicans predictably cast doubts on that scoring, basically saying the CBO’s math was wrong, but offering inconsistent details. Republicans were consistent on one major talking point though- Trumpcare lowers health costs.

With this admission, Republicans and Democrats are now basically being honest about their health care values- Republicans want health insurance to cost less, Democrats want it to cover more people. While those things may seem like goals that could both be achieved at once, it isn’t that easy. If you go for broader coverage, you have to cover the old, the poor, and the sick, none of whom are cheap to cover, and require redistributing those costs among everyone. If you go for cheaper costs, you have to cover less expensive people, or less old, sick, and poor people. In a sense, it’s hard to square these competing goals.

The overriding reason balancing this equation is so close to impossible is kind of obvious- insurance companies are companies, and therefore have to make money. If you want them to take on more customers, they have to take on undesirable customers, and undesirable customers cost more to cover. If you let them cherry pick their consumers, and pick out the healthiest ones, it’s cheaper for them to do business, and they can charge less to make a profit. It’s simple economics for companies that need to take in as much as they can and pay out as little.

Unless we’re going to discuss expanding Medicare and Medicaid, there really isn’t any way to both expand access to coverage and lower costs. Given the difficulty in passing the Affordable Care Act for Democrats, and Republican opposition to expanding the government on any domestic program, I don’t see that happening in a transformative way any time soon. In other words, I don’t see any magic solution to the coverage vs. cost divide.

If you ask Republicans, the biggest issue facing the health care market is the cost of insuring people. If you ask Democrats, the biggest issue facing the health care market is achieving universal coverage. Republicans see the cost of insuring the masses as a burden, which is why they want to turn Medicaid into a block grant, and why they are opposed to expanding Medicaid and Medicare. Democrats want to expand those very same programs, even if it has some cost. If we’re really being honest, this is the divide on health care policy, and has been for quite some time. It just hasn’t been this clear in a very long time.

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