The issue of health insurance in America should be a lot simpler than it’s made out to be. All the way back in the 1930’s our country made the decision to go a different way that every other major democratic nation by opting for an employer based health insurance system. This decision was entirely ideological in nature. Right wing opposition to anything that even hinted at the great bugaboo “Socialism” made it impossible for us to have a national health care system like every other major nation.
This decision made major problems with our health care in the US inevitable right from that moment. Our system virtually ensures that millions of citizens have no insurance whatever. First of all, there are the unemployed. No job, no insurance. Add to that, our massive number of “underemployed”. Congress rightly decided that small businesses couldn’t afford to provide insurance to their employees so they were exempted. Additionally, only full time workers generally received benefits so larger corp[orations used as many part time workers as was feasible to avoid paying benefits. The chronically “|underemployed” could be working two, even three part time jobs, just to pay the bills and receive zero benefits.
Eventually a patchwork system of work-arounds brought the number of uninsured down. Medicare covered the citizens over retirement age. Medicaid was set up at the state level to cover the poor who otherwise couldn’t afford to be covered. Of course this left large disparities between the states as to how well they took care of their poor.
So, even with the additional programs filling in some of the gaps, as many as 48 million citizens were still uninsured (a 2012 figure). These many millions tended to end up using the emergency care infrastructure for their basic health care which was, by far, the most expensive way to provide health care services. Additionally, we got to the point at which even for those who had coverage of some sort, many had plans that denied coverage for existing conditions, had huge deductibles which made it impossible for the unwell to afford to get care. The result was that under our system, the number one cause for personal bankruptcies in the US is medical costs.
So now, the Republicans are in power. They have steadfastly opposed the provisions of the ACA, also known as Obamacare, since it was passed. But the effort to repeal and replace the ACA is revealing an ideological divide on the right. The Trump / Ryan plan does a massive tax cut that goes mostly to the wealthiest Americans, puts up to 26 million people back into the ranks of the unemployed, pushes more costs onto the consumer and also places a heavier burden on the states, which probably do not have the tax base to fill in the void.
But, the repeal is running into problems, not from the outnumbered Democrats who appear to be 100% against the repeal on principle, but from the ultra right wing of the party. These folks are the radical “libertarian” wing known as the Freedom Caucus in the House. These people, if left completely to their own devices, would have almost no government role in health care at all.
So, what the Republicans are struggling with is a choice between two plans, one of which screws the poor, the elderly, disadvantaged women, and so on and reduces the share the wealthiest pay to support the system and a complete devastation of the health care system that would pretty much screw everyone not able to afford his own insurance at free market rates. This is a fight that totally leaves out GOP moderates… It is between far right Congressional representatives who wish to shrink the government role in providing health care but are mindful of voter back lash and are worried about pushing the effort so far that they get demolished in the 2018 mid-terms and the ultra right libertarian fanatics who simply do not care about the voters at all and see themselves as fighting for small government and maximum privatization, screw the folks who can’t afford it. These are the folks that see any and all government benefits as removing the incentives of the poor to get jobs and get to work.
In other words, Democrats may rejoice that the GOP is divided and this temporarily is delaying the repeal of the ACA, but the negotiations about how to compromise on the Trump / Ryan plan and get the Freedom Caucus people on board will not result in any improvement but rather result in a compromise plan that is even worse, if possible, than the original. It will result in tens of millions losing coverage, sky high deductibles, more excluded conditions, the middle class covering more of the costs relative to the super rich, and so on. It is an unmitigated disaster for health care in the US and will result in far higher medical costs for the country in the end.
Once again we see the Republican commitment to take from the poor and give to the rich fully revealed. It is a morally bankrupt effort and we as a country should be ashamed that this is the direction we are choosing to go.
How We Ended Up with Employer Based Healthy Care