Two things are easy for everyone to agree on: Obamacare was a noble idea that isn’t working, and what Republicans are pitching as a replacement is far worse than Obamacare.
Beside those certainties, American health care reform is chaos.
How American health care works — or more accurately, doesn’t work — is vastly complicated and exasperating. It’s a hodgepodge of philosophies, regulations, laws and endless contradictions. Obamacare was an attempt to reduce the individual costs of health care and force insurance companies to deliver value and fairness. It was doomed from the beginning because it tried to create a better system for consumers without structurally changing it. Without regulating costs and controlling premium hikes, suppliers endlessly hiked prices and insurance companies demanded higher premiums. While Obamacare infinitely improved how consumers were treated by insurance companies, fewer people in the vast middle class can afford it any more.
Trumpcare, as proposed by House and Senate Republicans, only makes an increasingly bad health care system dangerously worse.
Numerous outside experts and analysts agree that it would immediately make health insurance more expensive for Americans who are already struggling with the cost of Obamacare. If you’re between the ages of 50-65, you’ll pay more than anyone, and you’ll pay much, much more than you do now. If you don’t pay, your employer will, putting millions of American jobs at risk as companies struggle with these costs just like citizens are.
Trumpcare would not only push people out of insurance immediately, it would result in better than 20 million Americans becoming uninsured above what uninsured predictions are with Obamacare. Who’s demanding “no” votes on this bill? Just about every single organization of doctors, nurses, technicians, hospitals, the AARP, myriad patient-advocate groups and almost every health-insurance company in the country.
The only winners with Trumpcare are the very rich, who would see hefty tax cuts, in the tens of thousands of dollars a year.
Setting aside the ethical quagmire Trumpcare unleashes, here’s what Congress must deal with to come even close to solving the problem:
There are millions of Americans who pay nothing or relatively little for health care each year. The country spends about $600 billion a year just on Medicaid spending. On top of that, hospitals provide about $40 billion a year in “uncompensated” care to sick people who don’t have insurance or Medicaid. And on top of that, hospitals report that they lose another $60 billion a year or so from Medicaid and Medicare reimbursement rates that are well under actual costs.
It means that we continue to play a shell game on how to pay for about $700 billion in health care for people who can’t or don’t pay for some or all of their care.
While many Republicans say they don’t want to offer free care through Medicaid to so many poor people any more, it’s not that simple. White House advisor Kellyanne Conway summed up how ludicrous the issue has become by explaining that many Medicaid recipients can just get jobs with health benefits and get off the public dole.
Besides being cruel, the notion is naive. What she and many Republicans fail to admit is that the nation’s uninsured and poor have long gotten health care and will in the future. A federal law demands that hospitals treat emergency patients even if they can’t pay.
Nobody disagrees that treating people in emergency rooms is the most expensive and unproductive thing we can do. So by providing vastly cheaper care to poor people before they end up in emergency rooms, everybody saves money.
The way the system works now, even under Trumpcare, reducing or even ending Medicaid would only shift hundreds of billions of dollars in government spending on indigent care to the hospitals and providers, who would pass those costs onto paying customers.
Before Congress decides what it’s going to do with Obamacare, we first must decide whether we will allow millions of people to die or flood emergency rooms because they lack health care they can’t afford.
We would hope not. And if we don’t, then Congress must in the short-term prop up Obamacare to keep the system working. Jacking rates through the roof and forcing huge expenses onto an already shaky hospital system, especially in rural areas, is not only cruel, but it’s political suicide for Republicans. The only way to create a compromise we can live with in the short term is through bi-partisan negotiation in both the House and Senate. Moderate Republicans and Democrats are much closer on this issue than the spectrum of Republicans. That bi-partisan block is strong enough to get the job done.
Even then, such a fix will be unsustainable.
If we provide free or subsidized care for millions, we can do it only one way. The only answer is some type of universal care.
But for now, we have to keep the system working as it does until the inevitable becomes reality.