The legendary American philosopher Yogi Berra supposedly said, “If you don’t know where you want to go, you’ll end up someplace else.” That is the story of American health care. We have not decided whether health care is a “right” for all Americans or a “privilege” for those who can pay. It seems that health care is a right for some of the people all of the time and for all of the people some of the time but not for all of the people all of the time. If you find that confusing, then you’re on the right track. We haven’t chosen our destination and we have arrived at a place that confuses and frustrates us.
Health care with little or no out-of-pocket expense is a lifetime right for veterans and for prisoners serving life sentences. I can’t think of any other large groups who have that benefit. Medicare eligibility bestows a permanent right to most health care for those who pay their out-of-pocket share. The rest of us have temporary and partial rights that depend on our employment, wealth, personal choices and luck.
Our national debate should be about who has a right to health care, which elements of health care are included, who will pay for it, and how the cost will be paid. Arguments about whether or how to replace or repeal ObamaCare (the Affordable Care Act) are pointless and counterproductive until we make a firm national decision about whether health care is a right. Where do we want to go?
Critics of ObamaCare point to extremely high insurance premiums in some of the exchanges where insurance is sold to individuals and small groups. Some areas of the country have only one insurance company participating in exchanges. Those problems are real but correctable. They occur in local segments of the healthcare marketplace and are worst in states that resisted ObamaCare by refusing the Medicaid expansion.
Here’s a snapshot of what ObamaCare has accomplished. The annual rate of increase in health care spending (both government and private) was 3.3 percent before ObamaCare. It dropped to 2.7 percent after ObamaCare was implemented. Simultaneously, the number of uninsured Americans decreased by 20 million. That is a picture of success.
President Trump’s promises sound amazingly like President Obama’s. For example, on January 15, 2017 Mr. Trump said, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” …People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.” In the same interview, he claimed that the people covered by Medicaid expansion would continue to have coverage.
A credible replacement for ObamaCare should improve on its performance. But according to the Congressional Budget Office (non-partisan and under Republican supervision) the bill that Republicans tried to rush through congress would have led to 52 million uninsured (4 million more than before ObamaCare). Less thorough analysis from the highly respected Commonwealth Fund agrees. The President and Congressional Republicans dispute the CBO estimates but they have produced no research to support their conclusions. It’s all based on their opinions.
Two principles of ObamaCare are that basic health care is a right for all Americans and that everyone should be required to participate in the cost. Those principles are implemented through the individual mandate to purchase approved coverage along with Medicaid expansion for the very poor. Approved coverage includes services for prevention and early diagnosis of health problems that often lead to premature death, disability and extreme expenses. The Republican plan lacked similar features and would produce more late stage diagnoses of illnesses that were preventable but not curable once they occur.
Because there was no individual mandate in the Republican bill, there would be two options for care of those who don’t pay. Either provide the care and build the cost into the bills of those who do pay or let those who can’t pay suffer or die without care. The individual mandate is better than either of those alternatives.
What should we do? I have asked for a meeting with my (Republican) Congressman. I want to show him the evidence that I’ve found and I want him to show me any evidence that the Republican replacement would produce better results. What will you do? Your answer will come to you after you decisively answer this question, “If the person that I love most in this world is sick and broke, does she /he have a right to health care?” ___________________________________________________________________________
Evaluate performance data from the US and other developed nations HERE using tools developed by the Organization for Economic Cooperation and Development.
This prior column contains links to references and more evidence.