If Government Doesn't Make Decisions On Your Health Care, For-Profit Insurance Executives Will

This week, Republicans are going to try, once again, to repeal Obamacare. Thanks to Susan Collins, Rand Paul and John McCain, it looks like they’ll have a tough time of it, but we still need to keep the pressure on. Either way, as the latest analysis from the Kaiser Family Foundation demonstrates, the Graham-Cassidy bill will, by slashing funding, decimate Medicaid as well as the Obamacare system of guarantees and premium subsidies. Paul Krugman rightly summed up the Republican approach behind the bill as “Cruelty, Incompetence, and Lies.”

In a remarkable show of bipartisan opposition from people with real expertise, the National Association of Medicaid Directors, i.e., the 50 people who run Medicaid in each state, put out a statement urging senators to reject Graham-Cassidy and revisit the issue after it can be properly considered.

As Greg Sargent explained, what’s so unusual about the statement is that this wasn’t just a pronouncement from the smaller board of directors, but one that was backed by a significant number of Medicaid directors in red states, including ones where their Republican governor had come out in favor of Graham-Cassidy. This is a “politically sensitive” thing to do. Sargent spoke with the NAMD’s executive director, and learned that “many Medicaid directors from red states privately said they were comfortable with this statement getting out to the public and lawmakers, and in many cases, they eagerly wanted this to happen ... To be clear, this is actually unusual.”

So the content of the bill—like that of every attempt thus far to repeal Obamacare—sucks. So let’s spend some time breaking down one of the core intellectual (and I use that word quite loosely here) arguments behind the GOP’s attacks on Obamacare and on just about any progressive proposal on health care.

“Keep your government hands off my Medicare!” Remember Obamacare opponents shouting that at town hall meetings? (Note: I assume most of you know that Medicare is wholly and completely run by the U.S. government. Just checking.) Despite the reality that 118,395,000 Americans—almost 37 percent of the people currently living in our country—receive health insurance through the government, Republicans play on that fear of and hostility toward government involvement in health care.

Conservative politicians and pundits scare people about the idea that “government bureaucrats” will be making decisions about their health care. Graham-Cassidy proposes to remove all kinds of federal “decisions” that affect health care, things like the guarantee that people with pre-existing conditions will be able to get coverage. What a nightmare it must be for those people to have government involved in their health care. (Sorry, is my anger showing?)

Republicans have hyped these fears in order to distract voters from a simple reality when it comes to health care: unless you pay completely out of pocket, someone other than you is going to be making important decisions. Someone is going to decide what gets covered and what is not covered. The question is: who should be making those decisions, and who benefits from the outcome of those decisions?

In an unregulated, Wild West-style private health insurance market, the people making all those decisions will be high-salaried management officials at for-profit health insurance companies. They have one incentive, and one incentive only: to cover as little as possible without losing too many customers. Profit, not care, is their highest priority.

Conservatives talk about “rationing,” but the worst form of rationing is when people who don’t make enough money to get insurance and can’t afford to pay out of pocket go without health care. Government, by subsidizing the cost of premiums or by enrolling people in a program like Medicaid, makes sure that care isn’t rationed for millions of Americans for whom care would be otherwise impossible to afford.

The Republican lie is that government rules and regulations mean a reduction in your ability to make health care decisions. That’s simply not the case. Those rules and regulations govern what companies can do—such as, to cite a few elements of the Obamacare law, preventing them from denying people coverage because of pre-existing conditions, requiring them to allow children to stay on their parents’ policies until age 26, requiring them to cover contraception without a co-pay, etc. These government rules do not reduce the ability of citizens to make their own health care decisions; in fact, they give citizens more and better options.

Furthermore, government rules on health care come from laws passed by our elected officials. The people choose their representatives. That’s called democracy. Our democracy is, without question, imperfect, but we at least have the opportunity to hold elected officials accountable. If you don’t like the rules set forth by an insurance company—or the whole industry in some cases—what exactly are you going to do to hold someone accountable? Good luck with that.

What Republicans ignore is that it really is an either/or question: do you want insurance company executives setting the rules that govern your health care, or do you want the people’s representatives doing it? When conservatives say that less government involvement means more “freedom,” they are denying the fact that that’s simply not the case for all except the wealthiest among us.

Those, of course, are the only people Republicans actually serve, whether the issue is health care or any other. The lies and deceptions are all aimed at hiding that reality.