It seems to me….
“The American public believes that health care is a right and not a commodity.” ~ Michael Moore.
As a basic requirement in order to belong to their club, Republicans are obligated to condemn the Affordable Care Act (ACA), which they derisively insist on calling “Obamacare” though it basically originated as a Republican measure, as being bad for business and eliminating jobs – even though the U.S. has gained over 5.7 million private sector jobs since it was enacted in 2014. As a result of the ACA, over 90 percent of U.S. citizens are now covered by some form of medical insurance. Additionally, according to a recent study, people living in states that expanded Medicaid under the ACA are, on average, less likely to have medical debt, more likely to receive preventive care, and have lower long-term medical costs. Moreover, the growth of healthcare-related spending as a percentage of GDP has slowed since passage of the ACA.
While the ACA did not result in the degree of healthcare improvement for which many had hoped, and was in many ways hobbled by compromises needed to obtain passage, it remains a foundation upon which to build. It would be far better to take the good and simply modify rather than attempting to totally repeal and start over strictly for ideological benefit. As a nation we deserve better than politically motivated one-upmanship – if the Democrats win control of Congress in 2018, would they then attempt re-repeal and replace whatever plan Republicans approve? This is of benefit to no one and needs to stop.
It was hoped that with federal financial assistance available under the ACA, health insurance would become affordable for significant numbers of low-income Americans but even with the subsides it provided, that assistance remained insufficient for many.
For many extreme conservatives, the ACA went too far in providing healthcare to those economically challenged and provided insufficient tax benefit to the wealthy; for liberals, it failed to provide sufficient care to many at a reasonable cost. The proposed Republican replacement, developed in secret by a small select group (after strongly criticizing Democrats for the same tactic) made no effort for bipartisan input.
The nonpartisan Congressional Budget Office determined that the healthcare bill passed by the House in May 2016 would leave 23 million fewer Americans with health insurance by 2026 than under the ACA; the Senate Republican healthcare bill currently up for consideration would leave 22 million fewer Americans with health insurance.
The proposed bills eliminate the insurance mandate requirement and would transform the Medicaid program to a per-capita cap basis limiting Federal funding for the least healthy including long-term Alzheimer’s, long-term care, and others with serious illnesses. The legislation’s tax cuts would be very beneficial to wealthy Americans and health insurers and providers who would get a trillion dollars in tax breaks. The legislation would be disadvantageous to recipients of current tax credits who are older, sicker, and poorer and live in areas where care is more expensive. They might be able to afford low actuarial value coverage with the tax credits the bills would provide them but they then would most likely be unable to afford the cost sharing that coverage would impose.
Higher-income younger people, on the other hand, would find coverage under the legislation much more affordable than it is now – the tax credits might fully cover their premiums and leave extra for their health savings accounts. Some insurers could find the state reinsurance money and continuous coverage requirement enough of an incentive to stay in the market but others may not. Without further analysis, it is difficult to see how the bill could pay for itself and it could quite possibly result in significant losses in coverage.
It should be obvious to anyone with even the slightest bit of consideration, compassion, or empathy for those with medical issues that neither the House or Senate proposals are acceptable.
Perhaps the best alternative is a rejection of both the current ACA and the Republican proposed replacements. As U.S. Congressional politicians debate the future of healthcare, the notion of a single-payer healthcare system to simplify and expand coverage is increasingly being discussed. According to a recent poll by the Morning Consult and Politico, 44 percent of Americans favor a single-payer healthcare system. The U.S. is one of the only countries in the developed world that does not have such a system in place.
Single-payer, or Medicare for All as it’s sometimes referred to in the U.S., is a system in which all healthcare financing is provided by one entity, such as (but not always) the federal government. All residents receive core coverage regardless of income, occupation, or health status.
One of the glaring weaknesses of both the ACA and the proposed Republican replacements is that a market economy will not care for the sick unless it can be paid for. Insurance can help up to a point but insurance companies have no interest in covering people they suspect will get sick. Unfettered markets result in only those who are wealthy and/or healthy enough that they will not frequently need healthcare insurance being able to get coverage.
Similarly, insurance companies can be required to not discriminate based on medical history but that would result in higher premiums for the healthy. An incentive can be created to stay uninsured until or unless you get sick which pushes premiums even higher. It therefore is necessary to regulate both individuals as well as insurers mandating that everyone sign up. Since some people won’t be able to obey such a mandate, subsidies which must be paid for out of taxes are necessary.
The U.S. spent about 17.8 percent of its gross domestic product (GDP) on health care in 2015 – a much higher percentage than for any other major country. This averaged out to about $9,990 for each man, woman, and child. Actual spending, however, is distributed unevenly across individuals, different segments of the population, specific diseases, and payers. Only five percent of the population accounts for almost half (49 percent) of total health care expenses. The 15 most expensive health conditions account for 44 percent of all health care expenses. And patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition.
As the cost of healthcare has increased, it has become more difficult for individuals to afford private plans. Employer-based healthcare plans discourage someone who wants to start a new business as they are hesitant to leave whatever job they currently have as they would lose their employer-provided health insurance with no guarantee that they could ever get insurance on their own for themselves and their family. Additionally, the current U.S. healthcare system is a burden on companies making them uncompetitive with manufacturers in other nations with single-payer systems.
There is little possibility that the U.S. will ever change this situation as insurance and pharmaceutical companies have too powerful a voice in Congress to permit it to happen. The ACA passed under President Obama was a very weak bill with numerous shortcomings necessary just to get a few critical reforms. Conservatives who object to the approval of any healthcare measure, have repeatedly tried to cut funding for implementation of even modest reforms and now are attempting to totally repeal the measure.
A single payer system would simplify all of this by largely cutting out the insurance and pharmaceutical companies untethering coverage from employment. Middlemen, like private insurance companies, who make the current system so frustrating to navigate and politically fraught, would be the only losers.
Everything from dental care to long-term care would be covered for everyone under a single payer system equalizing treatment between the affluent and less affluent. Medicare, for which everyone over 65 can qualify, is an example of a generalized universal public medical financing system in the U.S that demonstrates such a system would be successfully here.
It is time for both political parties to put aside their differences and attempt to reach a compromise – not only on healthcare but other critical issues such as the environment, immigration, education, infrastructure, tax reform…. But that, given the current political reality, would not be realistic.
That’s what I think, what about you?
 Michael Francis Moore is an American documentary filmmaker and author.
 Jost, Timothy. Examining The House Republican ACA Repeal And Replace Legislation, HealthAffairs Blog, http://healthaffairs.org/blog/2017/03/07/examining-the-house-republican-aca-repeal-and-replace-legislation/, 7 March 2017.