As I write this blog, Senate majority leader Mitch McConnell is still trying to resurrect the Republican effort to repeal and/or replace the Affordable Care Act of 2010 (ACA), so-called "ObamaCare." This post isn't intended to be a discussion of the health care debate per se nor my own views/positions on this issue. There's enough opinion out there to keep people amused for a while. However, I did want to make a few points that I think are being lost among the rhetoric from both sides of the argument. Apologies, as this post may end up being a bit disjointed, given the complexities of the issue.
The first thing that comes to mind is that the ACA nor the American Health Care Act (AHCA) really has anything to do with health care per se. This is an insurance debate, which under some conditions will improve the health care for some Americans, especially those who previously could not previously access affordable health care, but does next to nothing to actual tackle the problems of reducing the overall cost of health care nor actually improving the quality of health care. So folks should not be under the illusion that either plan actually improves the quality of health care in this country. While on this topic, it is important to emphasize that despite being the richest country in the world, the United States does extremely poorly in terms of actual health care for our citizens; we definitely are not ranked at the top. That's extremely sad that a country so rich cannot ensure that its citizens can get adequate and competent health care at a reasonable price.
Since this does boil down to a discussion of insurance, access to insurance, and the cost of insurance, it's important to remember what insurance really is. One side seems to think health care is a right and everyone should be provided health care. The other side seems to think insurance is a product, should be treated as such, and therefore free market economics apply. Sadly, both sides forget that insurance is about risk and managing risk. Access to affordable health care (insurance) does not equate receiving adequate health care (actual care). In order to provide affordable insurance for all, the risk has to be spread across all. Therefore, if you want insurance to be affordable, you either need to do something about the actual cost of health care or you have to spread the risk across everyone. Ideally, you want to do both. Since Congress is very unlikely to want to regulate actual health care costs, that only leaves the option to spread the risk. So, the argument that healthy people should not be forced to purchase health insurance only weakens any plan to provide accessibility to health insurance for all. Look at the example of car insurance; not a perfect analogy, but sufficient to make a point. In almost all states (I believe Virginia and New Hampshire are the exceptions) everyone who drives is required to have some form of car insurance. It doesn't matter whether you've had an accident or not. By doing this, the risk and subsequent cost of insurance is spread across all drivers. Yet, I'm not aware of loud protests of forcing "safe" drivers to have insurance. In fact, since nobody knows if/when they'll have an accident, spreading the cost of the risk across all drivers makes sense. The same is true of health care. None of us knows if/when we're going to get sick or whether that illness will be something minor or major. Can you imagine what car insurance costs would be like if "safe" drivers were exempt and only "unsafe" drivers were required to obtain insurance? I fully support the idea of freedom of choice advocated by some, but if you really want everyone to have access to affordable health care, then some sacrifice to that freedom will be necessary, in the absence of going to a model of socialized medicine.
Which brings up the issue of cost. There are those who would argue that free market economics should apply to health care and that competition will drive the market and reduce costs. Sadly, these folks seem to forget that's what we essentially had prior to the ACA. While the principle of free markets sound good, the health care market isn't like buying a car. Pricing is hidden from the consumer and even if there was transparency in pricing, "shopping around" is made more difficult based on the fact that you're care is typically tied to a particular physician or health care plan. Research shows two-, three-, and sometimes multi-fold differences in pricing for the exact same procedure across health care providers in similar geographic regions. How can the same procedure, performed in nearly the same way, have such a large cost differential? More importantly, how can competition drive pricing if you don't know what the prices are and health care systems are unwilling to reveal those prices? Free market forces will only work in health care when transparency becomes more of the norm. Yet those advocating for free markets are not likely to create legislation to make those markets more transparent for consumers.
Politicians always talk about what the American people want. I've heard people on both sides of the aisle start their statements with "The American people clearly want blah, blah" and then justify whatever thing they're talking about. You can usually find support on either side of an argument and depending upon which part of the country the politician represents, that statement can have some truth to it (although, they probably should say "Americans in my district" or "Americans in my state"). However, in terms of the health care debate and the AHCA, it appears that very few, if any, health care constituencies support the AHCA. Overwhelmingly, insurance companies, health care providers, professional medical groups, public health advocates, disease-based non-profits, and other parties have all raised concerns about the AHCA at one level or another. Clearly, those entities that need to be a major part of the AHCA don't think this piece of legislation is good for Americans. Yet, the politicians don't seem to hear their views and keep talking about what "The American people want." This is one issue where politicians need to be listening to the professionals.
I have constantly harped about political expediency and lack of political leadership. Well, we're seeing a good example here in the health care debate. The ACA was a reasonable attempt to improve access to health care in the US, but it was not perfect. But, rather than trying to fix and improve upon it, foes of the ACA chose to run on the idea of repeal. While President Obama was still in office, there were multiple attempts to repeal the ACA. These were politically expedient votes, because those against the ACA knew their votes could generate the appearance of a principled stance that had very little risk of any real responsibility, since President Obama would always veto the bill. Now, that political expediency needs to morph into political leadership, these individuals are now finding their path to "repeal" or "repeal and replace" is fraught with all kinds of difficulties. Rather than show leadership, govern, and fix the ACA, they are now trying to maintain their "repeal" positions while trying to come up with an alternative plan. Why does there need to be an alternative? Why can't these individuals work with others across the aisle to help Americans get what they need? Why is loyalty to party more important than loyalty to country? This issue should not be used as a political football, since peoples' lives and livelihoods are at stake. However, what puzzles me the most is how these people, like members of the House, can stand there have big smiles on their faces, claim the alternative plans they've proposed are "better" when millions would lose health insurance and others would end up paying more. Those millions are real Americans with real health care needs and they are not likely to get adequate health care and are at extreme risk for a short life span. How can politicians justify playing with peoples' lives with a big smile on their face? In fact, the extreme need to defend their own plans, however bad, leads to some to justify their vote in support by saying ridiculous things like Rep. Raul Labrador (R-Idaho) - "Nobody dies because they don't have access to health care." The least they can do is admit coming up with comprehensive legislation for health care is difficult, look a little somber, and say they tried their best to meet the expectations of all their constituents, but that some will have to pay more for insurance or not be covered at all. These smiles and claims of victory just show these people are not serious about the real-world consequences of health care legislation. Oh, and by the way, the claim that the ACA is "failing" or "is in a death spiral" or some of the other descriptors is really self-serving. The reason for the turmoil in the exchanges has to do with one of the weaknesses of the ACA; it relies on funds to be approved by Congress. Without those funds, plus the ambiguities of the future of health care legislation, both falling under the responsibility of the Republicans, the exchanges in some areas are teetering on collapse. However, most of that would disappear if Congress votes to provide the subsidies or provide a clear vision for health care. Thus, they are primarily responsible for the so-called "collapse" of the ACA and people having difficulties finding insurance or having to pay more for it.
In the end, legislating health insurance is difficult. There are difficult choices and significant consequences for each choice made. This is one issue where those on the extremes of the political spectrum, have to take a step back and allow for governing from the middle. No legislation will be perfect and there will be losers. But we cannot be passing legislation where anywhere from 16 to twenty-something million Americans will go without access to affordable insurance. That can't happen in a country that is as wealthy as we are. Yes, freedom of choice is important. Yes, government shouldn't meddle in our personal lives. Yes, being fiscally responsible is important. But these all can't be accomplished by abandoning a large segment of our society as if they didn't matter. These politicians are playing with real lives with real life or death consequences. It's about time they take real responsibility and come up with a responsible health care plan for all Americans.
#LetsMakeAmericaBuenoAgain
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