The high cost of no healthcare
Millions face losing cover as Republicans attempt to dismantle Obamacare.
The United States Congress kicked off its 2017 session this week. Republicans are vowing to use their new and almost unfettered power to repeal President Obama’s signature legislative achievement – the Patient Protection and Affordable Care Act (otherwise known as ‘‘Obamacare’’).
From your kitchen table in a country with fully socialised medicine, it may seem crazy to want to get rid of a law that guarantees healthcare for millions and requires efficiencies in a bloated system – particularly in light of the fact that US heathcare costs are the highest in the world, and the number one cause of US personal bankruptcy is medical debt. Here’s what’s going on.
The US has historically had very limited public healthcare. Government healthcare for veterans can be traced back to before the Civil War. Federal programmes Medicaid (for the poor) and Medicare (for the elderly) were introduced by President Lyndon Johnson in 1965. The US model of employerprovided private health insurance as the primary mechanism for access to private healthcare has its roots in the Great Depression and World War II.
Seeking to keep their doors open, hospitals started offering deals to employee groups – a monthly payment for unlimited care. The war economy inspired employers to offer fringe benefits like healthcare to lure people to work. With that, the US medicalindustrial complex was born.
America’s road to some kind of universal health safety net has been long and winding, and is littered with political carnage. This year, Obama may join it, alongside Hillary Clinton, who tried (as first lady in the 1990s) to secure universal healthcare coverage. ‘‘Hillarycare’’ died on the vine, but probably laid the political foundations for Obama’s efforts nearly 20 years later.
The Republicans’ chief ideological objection to Obamacare is the individual mandate. Anyone without health insurance through their work is required to buy an Obamacare plan or face a tax penalty. This ensures a pool of people and payment, the fundamentals of any insurance system.
But in a country where individual liberty is paramount (and constitutionally protected), this mandate is criticised as interfering with personal freedom. Ergo, the liberty to not get insured and face financially devastating medical bills.
Compounding this ideological concern is the fact that Obamacare premiums are rising. This was politically toxic for Democrats in the general election of 2016, and Donald Trump made hay out of it. He neglected to mention, however, that one of the causes of the rising costs is that some states refused to put Obamacare into full effect, decreasing the available pool of contributors and pushing up costs.
No legislative solution is perfect, and no healthcare system is fault-free. In New Zealand, the price of a safety net is long waits for elective procedures, and roadblocks to care caused by under-funding.
Obamacare isn’t flawless. But it actually slowed the speed at which healthcare prices rose. It also ensured free preventive health services and access to birth control, and required that people with pre-existing conditions like cancer, or pregnancy (yes, a reason an insurer used to be able to refuse coverage), could get insured.
As Teddy Roosevelt said in the early 1900s, ‘‘No country can be strong whose people are sick and poor’’. The new American Congress would be wise to remember that. @MsDMcLaughlin