Once upon a time you could pay your doctor with chickens, but you always get what you pay for. Costs grew with technology until individual fee-for-service medical care became too expensive. Health insurance spread those costs to make health care affordable for decades, but the costs kept rising until the insurance itself became too expensive. Now our country faces a stark choice… leave medical care only for those who can afford it, or provide it to everyone and distribute that cost across the entire society. As the number who can afford care dwindles, pressure is growing for the second option. The Democrats had their shot and the Republicans just tried their best, but the fatal flaw hamstringing them both is not going away anytime soon…
Everyone except Donald Trump knew that “health care was complicated”, but the outline of the problem itself is very simple and non-partisan: we must have medical care so we must pay for it somehow. If direct pay gets too expensive we create insurance; if insurance gets too expensive we create… what? If the goal is to ensure affordable medical care for all then there are “righty” and “lefty” possibilities for solutions. But that’s not the goal; at least not for our purported representatives… their goal is to ensure medical care while keeping for-profit insurance companies in the loop. In 1991 health insurance and administration costs accounted for between 19% and 24% of total healthcare spending; an update to that study showed an increase to about 30%. No one but insurance lobbyists can explain why that’s necessary for success (and they only seem able to explain it to politicians behind closed doors) but it’s the fatal flaw that will kill any plan from either party.
The Democrats took the first crack at it. After 2 years of acrimonious debate the Affordable Care Act (ACA, or ObamaCare) passed with no Republican support in either chamber. The Democrats owned it. But, as hated, bureaucratic, complex, and ham-handed as it was, it seemed to be an improvement over the collapsing system it replaced. The number of uninsured began dropping to the lowest level in decades and premiums initially dropped as well. On the other hand, everyone still wasn’t covered, competition was feeble, costs were still rising, and they would continue to do so. Not a complete success, to be charitable.
The Republicans were next up to bat… Whether on philosophical, political, or economic grounds, they’d been united in condemning the ACA and voted over 50 times to repeal, defund, or cripple all or parts of it. They’d also been united in their deafening silence about the “replacement” to follow the “repeal”, but they aren’t the opposition party anymore and had to actually propose a concrete replacement. The CBO review of their first bill in the House said millions would lose coverage in the first year, more people will be without insurance than when ObamaCare started, those who have insurance will probably be paying more, and costs will still rise going forward. The White House’s own internal review was even bleaker. Not encouraging, (to be charitable once again) but that’s the bill the Republicans brought to the floor. The results of their non-vote show that while it’s easier to say something could be improved, it’s much harder to figure out how.
Winston Churchill wisely said “You can always count on Americans to do the right thing… after they’ve tried everything else.” Rational people know there’s no such thing as a perfect health care system. Even countries with universal coverage still bicker about rising costs or where money flows within the system, and there are still small numbers of people who can’t get care. But currently, even under ObamaCare, we have the highest cost of any healthcare system in the world and over 10% of our population has no access to care at all. We’ve tried the Democrat’s recipe and we almost tried the Republicans’, but they are both recipes for failure until the profit is removed from our health care thinking. It’s long past time to move on to the right thing… single payer. We all participate in the benefits, we all carry the load. And I, for one, am tired of corporations profiting and politicians grandstanding while real people die waiting for our representatives to try everything else.
Take care and make a great day,
18 Ridiculous Statistics About The Health Care Industry That Will Make Tear Your Hair Out, by Michael Snyder in Business Insider, Feb 2011
Do we really spend a third of health care dollars on billing and bureaucracy?, Ian Kullgren on PolitiFact, May 2012
The Reason Health Care Is So Expensive: Insurance Companies, by Jeffrey Pfeffer on Bloomberg News, Apr 2013
Paul Ryan Doesn’t Understand Insurance, The Young Turks, Mar 2017
Why Do Republicans Hate the Republican Health Care Plan? By Reihan Salam on Slate, Mar 2017
Republican Views on Health Care, Republican Views, Nov 2014
History and Timeline of the Affordable Care Act, eHealth, Sep 2016
Key Facts about the Uninsured Population, Kaiser Family Foundation, Sep 2016
Republican healthcare plan is not what the doctor ordered, by Patrick Tomlinson, The Hill, Mar 2017