The Republican health care ‘plans’
Republicans are gleefully touting the repeal of Obamacare as their first intended legislative action when they take control in January. What this means for the 20 million people who obtained health insurance through the Affordable Care Act (ACA) remains to be seen, along with the effects of this decision on those of us who get health insurance through employers. But the Republicans’ plan to replace Obamacare with a “free-market solution” will inevitably lead to chaos in health care delivery in the U.S.
The ACA was a complicated compromise that devastated progressives who wanted a universal health care system as enjoyed by most developed nations. By removing the middleman of private insurance, these countries spend far less of their gross national product on health care and get much better health outcomes. The United States with its private sector and “competitive” free market system is best known for limited access, poor care coordination and skyrocketing prices.
It’s no secret that prescription drugs cost more in the United States than anywhere in the world. That’s because other countries regulate prices while we let lobbyists talk our legislators into agreeing to absurdities like the prohibition on negotiating prices for the Medicare drug benefit. Our system is wasteful and tilted heavily against the consumer while ensuring high profits for the pharmaceutical and insurance industries.
The only part of our health care system that works well is Medicare, the universal health care product for all Americans age 65 and over. Speaker Paul Ryan can’t wait to dismantle it.
Ryan wants to privatize Medicare and give seniors a voucher instead, offering them “choice” in the morass of the private marketplace. Like the failed effort to privatize Social Security, the Republicans think senior citizens should fend for themselves and be responsible for finding their own insurance instead of relying on the government to provide a framework for everyone, a political miscalculation of mammoth proportions. Much has been made of the anger of the working classes who propelled Trump to victory. That rage will pale in comparison to the reaction of a growing elderly population when they discover the Republicans intend to “fix” Medicare with a private sector solution. They may not like government, but they love their Medicare.
President-elect Trump has signaled he intends to keep the popular parts of Obamacare, such as the prohibition against discrimination for those with pre-existing conditions and allowing young adults to remain on their parents’ insurance until age 26. But he wants to remove the individual mandate to purchase insurance, which will cause huge premium increases, quickly making insurance unaffordable for everyone.
Obamacare is far from perfect. Those who are self-employed and make too much money to qualify for a subsidy often pay an outrageous premium, especially if they live in the rural heartland where insurance companies have declined to offer competitive pricing.
Nevada has more at stake than most states since we had huge numbers of uninsured people, pre-ACA. If Medicaid expansion is repealed, hundreds of thousands of Nevadans will be left with no health care, and tens of thousands more will lose the subsidy that enables them to purchase plans on the ACA exchange.
Allowing people to be uninsured again isn’t going to solve our health care crisis unless we’re willing to close the doors of hospital emergency rooms and watch people die in the street. Assuming Americans are not that cold-hearted, we’ll revert to using our most expensive health care access point, the emergency room, as a clinic for the uninsured. And we’ll pay that bill through increases in premiums and hospital costs.
After the Republicans finish destroying Obamacare, it’s possible a universal health care system will rise from the shambles. It won’t be soon enough.