The health care travesty

For seven years, Republicans pursued Obamacare with the obsessiveness of Captain Ahab pursuing the white whale. Now they resemble a dog chasing a car, and catching it. Or Captain Ahab tangled up on the whale’s back and going down with it.

What they hated so much about Obamacare was never quite clear, except perhaps for the “Obama” part. It was based, after all, on what was originally a Republican concept, put forward as a market-based alternative to “socialized medicine.” Indeed, to get something done about all the Americans without proper health care, Obama had to give up the politically difficult government option, and to buy off the insurance industry by giving it what seemed a very sweet deal (selling more insurance).

Anyhow, for all their obsessing, Republicans never did have an alternative plan. Now their bluff is called. And, as a genius recently said, “Nobody knew health care could be so complicated.” Yet, whereas Obamacare was hammered out through an agonizing months-long process of give-and-take with input by numerous interested parties, Republicans have skipped all that, and whipped up a bill in the dead of night. Do you suppose they’ve really thought through all its consequences?

Trump had been saying his beautiful, tremendous, but unspecified, imaginary health care plan would cover everybody; with better care too, and at lower prices. Ha ha. Don’t we know by now that Trump just says stuff, with no thinking, or regard for truth, reality, or decency? Of course the now-unveiled GOP plan doesn’t cover everybody. In fact it would kick many millions out of the health care system. It replaces direct subsidies with tax credits — mainly so they can call it different from Obamacare. But it will give low income people much less help. While furthermore, removing healthier ones from the insurance pool will inevitably force premiums up. Most Americans will pay more for less coverage and less care. Older citizens will be particularly screwed. While the richest get tax cuts. When will foolish Trump lovers wake up that they’ve been conned?

Obamacare, at its heart, was based on making younger and healthier folks subsidize the old and sick by requiring everyone (on pain of tax penalties) to buy insurance . This is often defended on the basis that that’s how insurance works – like with car insurance, where safe drivers pay into the system, to cover accidents by others, while if you do have an accident, it’s there for you too.

Wellll . . . not so fast. Actually the concept of insurance is to spread a risk that the buyer wouldn’t want to shoulder alone. A house fire has low probability but unacceptable financial consequences, so you insure against it, spreading that risk among many others doing the same. But that’s voluntary, based on your own evaluation of the risk versus the cost of insurance.* You don’t buy fire insurance to help others, but because it’s worth it to you.

This original insurance concept has gotten perverted in the health care sphere. Like fire insurance, health insurance should cover only major episodes one couldn’t otherwise afford, not every routine little outlay. Doing the latter has meant that health care doesn’t act like a market, with consumers shopping among competing providers; a basic reason why prices have gotten so out of line. And it’s not surprising that Obamacare’s forcing people to buy such insurance, that they don’t judge to be a good deal for themselves, meets so much resistance.

But look. We are a very rich society. The basic idea that we, as a society, should take care of the less fortunate, and make sure nobody suffers unnecessarily, is a fundamental moral concept that most Americans would accept. That’s why even so amoral a creature as Trump would blurt it out (however disingenuously).

We have to come up with a way for every American to have at least minimally decent basic health care. The Republicans are not doing this; they are going in the other direction entirely. While the Trump-Putin administration’s proposed budget gives the Pentagon more billions to waste, and billions for the wall boondoggle, paid for by eviscerating everything else, including all kinds of government help for the less fortunate.

2012 Democratic campaign ad

For years, some Democrat partisans caricatured Republicans as heartless toward those less fortunate, as actually desiring to destroy programs like Medicare and Social Security, to keep poor people poor, and even to make middle class people poor, all just to (somehow) benefit the rich. It was a false caricature before. But Trump and today’s Republicans are making it true.

* Though the bank may require it, to give you a mortgage, because otherwise, if the house burns, you wouldn’t be able to meet your obligations.

One Response to “The health care travesty”

  1. Lee Says:

    Yes, your mortgage holder is going to require fire insurance. Your local building codes are going to insist on fire-safe electrical wiring. Especially when the property is in any way open to the public (e.g., dormitories, hotels) there will be requirements for sprinklers, smoke detectors, redundant exits, and similar. In total, whether required by government or private partners (like mortgage holders) there is a tremendous amount of “regulation” surrounding fire safety. We do this to protect ourselves, our property, and our financial well being, and I venture that the vast majority of us approve of the approach, big picture, subject only to possible quibbles about some of the details.

    Fact is, we are not willing to turn people away from hospitals if they need emergency care. Luckily, we can afford to cover emergency care for those who cannot afford it themselves. Fact is, people who get routine care will need more expensive emergency care much less often. Luckily, we are willing to pay for the routine care as well, because it saves us money. Fact is, when matters are this important, we are plenty willing to put up with regulations that help us to achieve our aims (subject to tweaking as necessary, of course).

    How precisely to achieve this more-or-less universal coverage is of course the big issue. I’d welcome Medicare for all. I’d welcome ObamaCare with some tweaks, where reasonable-quality health insurance is mandatory but the price is allowed to vary by the age of the covered, as the market would have it. That is, rather than having the young subsidize the old, I would go back to first principles and have the rich subsidize the poor. Generally, I would allow the prices to be market based, though with no extra charges allowed for prior conditions. I would find a way to strongly encourage states with few available plans to allow insurance companies from other states into their (free) markets for health insurance. The amount of subsidy to those who cannot afford the full price of the insurance would depend upon the cost to the covered for a reasonable-quality policy and upon the ability to pay; as much as 100% of the policy cost for the very poorest.

    TrumpNoCare has no mandate, no reasonable minimum on quality for a policy, and insufficient subsidies. It does not measure up to being called ObamaCare 0.5. I would benefit from TrumpNoCare in the financial sense, but am against it nonetheless.

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