The painful wake of the rush to kill Obamacare
Since the administration of our 33rd President Harry S. Truman, presidents have tried to address or avoid the question of providing health care for our citizens. The debate on whether a benevolent society should provide a minimum standard of care for every American teeters between notions of socialism and self-reliance.
In the last decade, extraordinary movement has taken place on the issue.
President Obama railroaded the Affordable Care Act (ACA) through a Democrat-controlled congress back in 2010 without sufficient consultation with the Republicans. Since its passage, the GOP has been in a state of rebellion against what we now casually call “Obamacare.” Now with a Republican-controlled congress and a Republican president, officials in control are rushing forward to either outright repeal, modify or homogenize the ACA. Although factionalism within the Republican Party have caused bitter differences between caucus members in their opinion about repeal and replacement, they all agree that keeping the status quo of the ACA is not possible.
No one can say that Obamacare did not have design problems that have propelled it toward its present state of critical mass. However, the GOP is recklessly trying to rush through a replacement before the proposed plan has been scored by the bipartisan Congressional Budget Office. It seems evident to any reasonable mind that considering health care is one-sixth of the United States economy and of the 23 million people who are currently insured through Obamacare at least 15 million will be immediately displaced without any coverage at all, that repeal and replacement should not be slammed through in a rush.
What kind of America do we wish to be?
As far back as 1854, the country has wrestled with providing health care for its citizens. Nurse/activist Dorothea Dix lobbied congress successfully for the “Bill for the Benefit of the Indigent Insane.” If this bill were not vetoed by our 14th President Franklin Pierce, the law would have provided a system of treatment asylums for the mentally ill.
Between 1865 and 1870, 40 hospitals were opened under the auspices of the “Freedman’s Bureau.” This was in many cases the first chance that the newly emancipated had ever seen a doctor. Unfortunately, the program was eventually defunded.
During Teddy Roosevelt’s 1912 third party run for the presidency, he adopted as part of his platform the progressive idea of national “Sickness Insurance.” Old Teddy did not prevail in his quest to return to office and the victor Democrat Woodrow Wilson had no interest in national health care.
After being informed about the United Kingdom’s effort at creating a “National Health Service,” President Harry Truman proposed as part of his “Fair Deal” the “National Compulsory Health Insurance Program” to provide health care for all paid by payroll taxes. Congress was hard lobbied against the notion mostly by the American Medical Association. Harry lost his battle to provide health care.
At least, the “Hill-Burton Act” did pass the following year. This law allowed minimum care access in emergency rooms and mental health centers for the poor and desperate.
Fifteen years later, Lyndon Johnson signed Medicare into law thus providing health care for those reaching the age of 65 years. President Richard Nixon extended Medicare to include the severely disabled under the 65 threshold in 1972.
In 1993, the First Lady of the United States, Hillary Rodham Clinton attempted to construct the “Clinton Health Care Plan”, casually known as “Hillarycare.” The effort was a total disaster.
Ten years later, President George W. Bush managed to get the “Medicare Prescription Drug, Improvement and Modernization Act” through congress. This law substantially lowered drug costs to seniors. Although it was a great step in the right direction, the costs for the program were significantly higher than originally estimated.
All these incarnations of health care for America were encompassed in the Affordable Care Act. Besides the fact that there was inadequate input from Republicans when the bill was drafted, the cumbersome bill was so utterly complicated and dense that the then-Speaker of the House of Representatives, Nancy Pelosi (D-CA) famously stated, “We have to Pass the Bill so that You can find out What’s in it.” Basically, the ACA relied upon perfectly healthy working people 18 to 30 years old to purchase insurance policies in order to supplement the indigent. Also, small business owners were forced to purchase insurance through exchanges in which choices were few, rates escalated and deductable amounts were raised, so that health suppliers could be compensated for losses elsewhere. Everyone was mandated to buy insurance one way or the other or they were subjected to penalty. This particular aspect of the ACA was strictly antithetical to our status as a capitalist democracy. Further, there was a built in disincentive to hire more employees or to have employees work full time schedules because the employer would have to supply medical care.
As fatally flawed as the ACA is, the law has insured 23 million more people which from a humanitarian point of view is a good thing. However, the lack of fairness on how that was achieved is the inherent problem with the scheme.
Oppositely, the Republican proposed “American Health Care Act” (AHCA) is being championed by the Speaker of the House Paul Ryan (R-WI). This bill seeks to phase out the expansion of Medicare under the ACA, eliminates mandates to force people to buy insurance, and it removes regional lines of availability so insurance companies can sell their coverage anywhere in the contiguous United States to promote rate competition. Also, tax credits will be made available to purchasers of medical insurance dependent upon ability to pay.
Most controversial, this new plan eliminates a luxury tax on investment earners who make over 250 thousand a year. This revenue was used to offset the supplementation of the poor receiving insurance in the ACA.
According to senior advocates like the AARP, the AHCA will raise rates most on the insured in the 50 to 64 year age group.
Cold and blunt, US Representative Jason Chaffetz (R-Utah) stated the following to those questioning the plan: “We’re getting rid of the individual mandate, we’re getting rid of those things that people said they don’t want.”
“So maybe rather than getting that iPhone they just love, that they want to go spend hundreds of dollars on, maybe they should invest in their own health care. They’ve got to make those decisions themselves.”
Other Republicans who are even more draconian in their stance simply want to eradicate Obamacare and worry about some sort of replacement later. Leaving 23 million people adrift does not seem to bother them at all. Led by Kentucky Republican Senator Rand Paul, an eye surgeon, 6 senators and 11 house members have strongly called for the simple repeal of the ACA without any replacement in place as a stop-gap.
Personally, I am distressed in regard to the health care dilemma in our nation. As a businessperson, I have endured more expense for less value as a result of the ACA. Yet, I do know that no one in our nation despite their material status should go without a minimum standard of health care. The question is this, are we truly a benevolent nation? If we are there must be a system that provides medical service for the most downtrodden among us. The ACA and the new AHCA tries to accomplish this task in differing ways. Simultaneously, affording this safety net must not unfairly burden those hard working small business owners or young independent workers. Of what is known so far, neither the ACA or the AHCA seem to be the answer. Perhaps before we rush to repeal the defective ACA, our officials should take a long deliberative study of the issue. Maybe the best experts in the field along with the elected from both parties could forge a successful answer to this conundrum without hurting the most desperate and the hardest working among us.
America has been working on providing health care since the 19th Century. Maybe a few more months of examination is warranted to get it right.