The cold hard fact is that insurance is about spreading the risk. Period. That’s how it works. If we allow those that are least at risk to opt out, there is only one possible result for those that are still in the system… higher premiums. That was the whole reason that we had the “individual mandate” in the first place. The mandate was essentially about “paying it forward”. You buy insurance when you are young when you need the least care. You are supporting the system for all the others who are older, less fortunate, or have chronic conditions. And then, at some point, you get old yourself. At that point your likelihood of incurring medical costs goes way up. So, it will be the young and healthy who are supporting your own care.
If we allow the young and healthy to opt out of the risk pool. Then the ONLY ALTERNATIVE is vastly higher premiums for the older, higher risk folks. This will be true at precisely the time in their lives when they can least afford it, at retirement when they are on fixed incomes. This is how insurance works. It isn’t magic. It’s a numbers game.
If we decide that we do not want to allow insurers to exclude people with pre-existing conditions (on which American seem to be united), then we have to have some form of broad, blanket coverage requirement. Otherwise people will simply forego buying insurance until they are sick and need it. Then they join the system without having paid into it when they were still low risk. That simply raises costs for everyone else. It has to.
Now, the obvious solution to this is to not “require” people to buy insurance but to “provide” insurance to everyone. A Medicare for all system in which heath care is treated as a public good and would be administered on behalf of our citizenry by our own government. But at this moment in time, with the GOP in control of Congress, that is a non-starter. So, instead, we are talking about trying to stop a plan that takes the country in precisely the opposite direction from where it should be going. It’s tragic but there it is.
The other deceptive piece of the AHCA is the idea that by reducing premiums, we have automatically provided health care to our citizens. But this is just another shill game. For profit insurance companies create lower cost premiums two ways. First, is simply by excluding conditions they do not wish to cover. Things like mental health coverage, prenatal care and maternity services, etc. The GOP bill, which purports to be a free market solution, does not prevent this cynical tactic. People believe they have affordable coverage only to discover that the services they need the most are not included. This was the basis of the substandard policies that the ACA did away with but the GOP plan would once again allow.
The second way is to create lower premium plans by jacking up the deductibles to the point at which the consumer cannot afford to actually use their coverage to get services because by the time they cover the deductible and then add in the percentage of the service not covered by the insurer, it is not affordable any more. In a nation in which half the country exists on the edge financially, with little or no cushion, policies like this mean that they forego routine care, live with conditions that markedly interfere with the quality of their lives, and end up being more likely to have serious and expensive conditions that could have been prevented. It is just another way to kick the costs down the road while creating the illusion that people have coverage. But it is coverage they can’t afford to use.
The Plan Doesn’t Cut Health Care for the Poor and Lower Incomes
It does, and by a lot. It is simply a fact that both the House version of the bill and the Senate versions of this bill will push as many as 23 million Medicaid recipients off the rolls. These would be the most vulnerable of our citizens, the poor who have little or no other means of getting health care. We know that failure to receive adequate health care costs lives. It’s as simple as that. The GOP plan is a death sentence for tens of thousands of Americans, period. For a party that once screamed about “death panels” it is inconceivable that they now support such a draconian attack on our nation’s poor and low income citizens.
The GOP has come up with a complex set of “tax-free health savings accounts and targeted tax credits” which supposedly help the poor defray the costs of coverage. But wait… think about it. Remember Romney’s 47% of the public that doesn’t earn enough money to pay Federal taxes? What good are tax free savings accounts to someone already poor enough not to be paying taxes? What good are tax credits for someone who will pay zero taxes even before the credit? This is nothing but a cynical sham, a ploy to make it look like the GOP cares about health care for the poor while pushing them out of coverage over time.
Since we as a nation long ago decided that we will not allow bodies in the streets, that we don’t turn away people at the emergency room when they need help, cutting Medicaid is just another way to shift the costs of health care to areas that are less obvious so the GOP can pretend they brought down premiums. Yes, premiums might be less for that smaller group can afford coverage but this is done at the expense of everyone else, and in the end, those people will be for the added costs elsewhere anyway.
The GOP plan either imposes lifetime limits of Medicaid benefits or allows the states to do so. Allowing the states to cap benefits is a sneaky way to allow the poor to get screwed without Congress appearing to be the villains… after all, it was the states.
So, once again, what happens to folks when they hit their lifetime benefit cap? Do they suddenly not require medical care any more? Of course not. The lifetime cap simply pushes people into bankruptcy, period. Even under our current ACA, medical costs are the number one cause of personal bankruptcy in the United States, one of the richest nations in the world. The Republican plan would magnify this problem by many times. In order to get a short term political win, it kicks the can down the road for tens of millions of Americans who would hit their benefit caps after the political racketeers currently in Congress will be out of office and retired.
Bankruptcies are the number one way that we hide the true cost of our health care. We allow our citizens to descend into impoverishment due to astronomical care and drug costs. Then we write that off when they declare bankruptcy. It’s a slick way of seemingly making those costs seem to disappear. But of course they do not really disappear. Those losses inevitably get passed on to consumers in other areas where they are less obvious as due to medical costs. And the folks that were wiped out of everything they had are left in poverty and seldom recover financially. Whole families are pushed to the edge of survival this way.
The United States has the highest per capita health care costs in the world. The GOP plan does absolutely nothing to address these costs. It is an attempt to use free market forces to deliver care. Well, free market forces are about profit. If we as a nation decide that the health of our citizens is a commodity meant to be bought and sold for the benefit of the investor class, then we have to accept that the price of profits is crushing poverty, debilitating illness, and even death for the many millions of Americans that do not have the means to be profitable as consumers of the free market health care product.
And all of this is to allow the GOP to deliver a massive tax cut to the wealthiest Americans. Eight men own the same wealth as the 3.6 billion people who make up the poorest half of humanity, and six of them are Americans. The top one tenth of one percent in America own as much as the bottom 90% of our citizens. This massive and widening wealth and income divide is an obscenity. And to create a health care system that is largely about not providing health care to many millions in order to protect this unprecedented, grotesque, level of inequality is criminal, immoral, unconscionable, and totally unjustifiable.
If any issue were to provide a reason for millions of Americans to take to the streets in protest, it should be the health care issue. This is the single most important issue facing our political system today. Not a single American isn’t effected on some level by this issue. It defines what our nation is to stand for, it is the moral underpinning of our society since it determines how we care for each other as Americans. The first step for us now is to stop this travesty of a plan in its tracks. It cannot be allowed to become the law of the land. It is a national disgrace that one of our two major political parties thinks that this is how we should approach health care.
Then, we have to get serious about real reform. The ACA has been crashing because we didn’t allow it to do what it should have done in the first place. A Medicare for all system is the only solution that would provide coverage for all Americans, remove the burden of insurance costs from our businesses, bring down premiums and give the government leverage to negotiate lower costs for the people. All the alternatives are band aids that will not accomplish what is really needed. Let’s get rid of the incomprehensibly complex insurance system, the hidden costs, the bankruptcies, and go to a straight forward expansion of our existing Medicare system to all Americans. Medicaid can continue to fill in the gaps for the poorest Americans who do not even have the means to contribute to the system.
No caps, no coverage gaps, no pre-existing conditions, just good health care for everyone. Health care should be a public good. It should be seen as a right that everyone in a society supports for the benefit of the whole. It should be the starting point for that level playing field that allows equal opportunity for all Americans. We have to get this right and we need to do it sooner rather than later.