It’s about politics, not health care. As the Senate GOP health care revision becomes public, one thing is clear, the intent has nothing to do with helping patients, rather, it is all about party image. In 2016 many Republicans ran on the issue of repealing and replacing Obamacare. It was a program they had repeatedly voted against funding, only to be defeated at the endgame. For seven years they brought the funding issue up, voted on it, and were rejected. We now know what they failed to do in all that time; develop a viable alternative.
To be fair, Obama-Care was seriously flawed. Too many people experienced significant premium increases. For some constituents, other promises failed to materialize. That included the ability for all to keep the doctor of their choice. With both high premiums and deductibles, the notion that it really was an “Affordable Care Act” (ACA) was demonstrably wrong. Like the GOP, the Democrats made the ACA a partisan issue, pushing through a knowing flawed product. As a result of the problems, a great number, even a majority of people, rightfully were very upset.
As a candidate, Trump pounced on the populist issue and made it one of the centerpieces of his campaign. According to his rhetoric, he would immediately “repeal and replace” the ACA. That replacement legislation he promised would be “great,” “far better,” “a lot less expensive,” and “cover everyone.” Based largely on perceived disenfranchisement, and the naivety of many voters, Trump managed to swing the electoral college in his favor.
Almost immediately it became clear that his promises for health care reform were all campaign bluster and he had no plan. Worse, neither did anyone else in the GOP. Despite hurricane-force warnings, Trump seemed shocked to learn about the complexity of health care in America. Turning to Congress, now controlled entirely by Republicans, he asked them to send him the magic bullet in the form of a viable health care bill.
As information about the House health care bill was scrutinized, many of the voters suddenly realized that they were the ones who were about to get screwed. That was especially true those people in states heavily dependent on Medicaid. Suddenly, approval of Obama Care increased significantly. While they had brought this disaster upon themselves, many Trump voters beseeched Congress to reject their proposed bill. Such pleas fell on deaf ears as the GOP members repudiated patients and placed their party reputation on the line.
The House narrowly passed their version of the bill and there was great rejoicing on The Hill and at the White House. It offered members a grand photo-op in the Oval Office. Soon, however, reality set in as the nonpartisan Congressional Budget Office (CBO) concluded that 23 million additional people would lose coverage. As facts emerged, Trump determined that his exuberance had been premature, and termed the House proposal as “mean.”
Next the Senate took up the issue. In secrecy, 13 white Republican men drafted a bill that still would make medical insurance unavailable for more than twenty million more people. Again, drastic cuts in Medicaid were proposed and those most impacted would be the elderly and poor. Women also would be negatively obstructed as emotionally oriented cries to defund Planned Parenthood resounded. In their first iteration, the Senate provided a gigantic tax break for the very wealthy, a political position they could ill-afford with 2018 looming. With minor modifications, such as no tax cuts, now comes a bill that is only slightly less horrible. Make no doubt about it, the GOP will find a way to reward the ultra-wealth.
As the debate rages, the plight of millions of average people seems of little consequence to the GOP politicians. The most significant issue for Trump and the party has become their pride in keeping the untenable campaign promise to repeal and replace the ACA. At all cost’s they want a significant victory in getting a bill, any bill, through Congress. Similarly, the White House seems prepared to sign any such bill into law. The one proviso is that it formally repeals Obama Care. The sensible approach, compromise that improves the existing system is deemed inviable. Recently, Trump even went so far as to proposing they just repeal the ACA and work on replacement later. While that violates his ardent campaign promise to make a switch simultaneously, Trump now views repeal alone as acceptable.
As Congress toys with the lives of millions of people, there underlies an even more fundamental problem. The health care issue has a fatal flaw that will insure the eventual demise of any current legislative measure. That is the premise that any such act must support the insatiable greed of the insurance industry. One of the proposed fixes for the current system is to increase competition, including allowing policies to cross state boundaries. With little and conflicting evidence to support their claim, proponents naively claim that such economic competition dramatically would drive down costs.
A major problem with commercial insurance is that administrative costs currently subsume a significant portion of the health care budget, while doing nothing toward the wellbeing of the patient. Estimates of administrative expenses run from a low of 25 percent of the costs, to as high nearly one-third of the money spent on medical care. While it is acknowledged that there are some reasonable administrative costs, the United States spends twice the percentage of amount paid in neighboring Canada, and considerably more than any other developed country.
Nearing 17 percent of the American GDP, our expenditure on health care far exceeds that of other countries, yet the results are demonstrably poorer. Access to health care is significantly disparate, especially in rural areas. Under the GOP proposals, with their Medicaid cuts, that will become far worse as many outlying facilities will be forced to close. Nationally, life expectancy is declining, infant mortality in some sections of the country is higher than some Third World nations, and coverage in general will be less available. With an aging population, not to mention burgeoning opioid epidemic, this bodes not well. The bottom line is we pay more and get less than comparable counties.
While significant, all of the blame cannot be placed on the insurance industry. It is recognized that hospitalization costs are exorbitant and climbing. If any doubt, check an itemized for hospital care. Consider that a single aspirin which can be purchased at any drug store for less than a penny, may be billed at several dollars each. I once found a simple vitamin pill marked up over 28,000 percent. In short, there is an urgent need to get medical costs under control.
Senator Bernie Sanders deserves enormous credit for proposing that health care should be a human right for every American. Of course, capitalists and strict constitutionalists cringe at the notion. But as Stephan Schwartz has repeatedly noted, America has an illness-profit system, one that is not focused the wellbeing of our citizens but on enriching owners and shareholders of the mega-institutions. The single-payer solution is both viable and morally right. As the richest nation on Earth, there is enough money to pay for it. Unfortunately, and unlike some advanced countries, a majority of our active voters place materialism over ethics.
It must be acknowledged that there is a substantial number of people on the far right who see the health care issue as one of entitlements, a word whose meaning has been perverted beyond recognition. Many of them come from a biased, theocratic position that has also perverted the fundamental aspects of Christianity. Counterfactually, they espouse beliefs that they are truly independent and their achievements solely derived from their own endeavors. Therefore, having acquired whatever material possessions they have, being expected to assist others in need is reprehensible in their eyes. The facts supporting the contrary position to self-sufficiency could go on ad infinitum, but are the grist for another piece.
At this juncture, any informed citizen must understand the current debate for what it is; a political ploy. For many members of Congress, we are but pawns to be expended for their personal goals. As if to prove the point, the GOP Senate proposal explicitly excludes themselves and their staff member, from being required to accept the same coverage they wish to impose on you. Not only is the GOP Senate ignoring the will of the people, they disgrace their office by placing politics above the safety and wellbeing of their constituents. The only thing worse is that many of their voters still will support their reelection.
P.S. As if on cue, as this article was written, McConnell delayed the vote on the Senate bill. If the senators were voting on the merits of the bill, that would not be necessary. Instead, the issue is party loyalty, and the American public the loser.