There’s a hurricane coming. It’s the bill being pushed by the House of Representatives to repeal the ACA. Like Katrina, or most Category 5 hurricanes that hit where human beings live, millions of people will be devastated if this storm hits our land.
Let’s be clear. My attempt here is not to make a political statement or take a red or blue side. My concern is mostly about the effects of the bill on the poor in America who will be left without any health care coverage if this bill ends up on the President’s desk.
What is the alternative? What would the opposite of this menacing piece of legislation achieve? Let’s make it simple.
The first question to be answered is whether health care is a right for everyone or a privilege for the wealthy. If you think it’s the latter, stop reading. My thoughts won’t reach you. If you believe health care is a universal right, then it follows that the maximum coverage makes sense. To start with, legislation must encourage, in fact demand, that business cover their employees’ health benefits. So commercial insurance matters. It’s the biggest source of support for most Americans.
Second, to get maximum national coverage, the young must be mandated to carry health insurance. The current mandate hasn’t worked. The penalty is more affordable than the coverage, so the young don’t enter the exchanges when they’re healthy. As with home-owners and car insurance, health insurance is a must for everyone. Yet the system can work, financially, only if it includes enough people who don’t file claims whose premiums pay for those who do: in this case, a healthy young cohort. The new legislation must include provisions that makes it more desirable for the young and healthy to opt into the system rather than pay the penalty for staying out of it, as they have been doing so far. We are all in one large national community, responsible for one another. It’s part of the privilege of citizenship. But to make it work, coverage needs to be universal.
In view of long-term viability of the health care system, care must come before the cure. All Americans must be able to see a physician on a regular basis. It’s the best way to maintain good health rather than wait until illness forces someone into the hospital. If we don’t see a doctor until we are struck with heart disease, stroke, or diabetes, the costs of health care are driven up exponentially. Preventive care is vital, and universal coverage will provide it. Early steps in nutrition, exercise, and preventive medicines are critical to keep people out of critical, intensive care. The ACA was designed to shift the emphasis from cure for disease toward care for good health. Universal coverage will help make that happen.
Finally, the federal government must expand Medicaid. The states are in financial straits. They cannot support many of the poor. Block grants are a dodge. They pretend to support coverage by passing the buck. They won’t work. We must deal with the reality that only the federal government can do the job.
Finally, the government just make sure that competition among insurers is supported and encouraged. The federal government has the resources to keep the policy prices down, through incentives and other measures. So when a healthcare bill comes up for debate, we need to review these basic considerations.
If these provisions are missing (for example, if 24 million lose their coverage), we have to protest. Get involved. Know that if a bad bill becomes law, the consequences, primarily for the poor, could be more devastating than the next storm of the century. If health care is a right, then let’s make sure the vast majority of us are properly sheltered and protected--and as we do that, let's keep the lights on in all of our hospitals. Without universal access to Medicaid, those lights will begin to go out in more and more hospitals—and that means less quality healthcare for everyone.