Health moves ensure misery
The Republican majority in Congress couldn’t agree on how to repeal and replace Obamacare, so President Donald Trump has destroyed the program from within.
The president’s decisions to stop marketing the health care program, to allow substandard plans across state lines and to cut off subsidies for the working poor will leave millions of Americans unable to afford insurance next year. That is, unless Congress acts quickly.
Trump promised that the Affordable Care Act would fail, and he’s ensured that will happen on Nov. 1, when open enrollment begins for 2018, and those who rely on the federal exchange discover that plans cost too much, if there are any available at all.
Fewer insured Americans, though, doesn’t mean fewer people will get sick. More uninsured Americans will mean more misery as people miss work because they can’t get treatment. More uninsured means more people using emergency rooms and then not paying their bills.
More uninsured means higher premiums for those of us with insurance, and we will pay higher local taxes to cover those unpaid bills.
Many readers will rejoice at Obamacare’s financial collapse. They repeatedly inform me that health care is not a right guaranteed under the Constitution, and that if people
can’t afford insurance or health care, that’s their tough luck.
Such cruelty, ironically, often comes from senior citizens whose health insurance is guaranteed under a federal socialized medicine program called Medicare. In any case, they are also half-right. The Constitution may not guarantee health insurance for all, but federal law requires emergency rooms to accept patients whether they can pay or not.
In America, we do not deny health care to people and let them suffer and die on the sidewalks outside hospitals. The challenge for our elected officials, then, is to find the most cost-efficient method of providing health care to those who cannot obtain it through their employers.
Everyone knows that an ounce of prevention is worth a pound of cure. Everyone knows that obtaining treatment in a hospital’s emergency department is the most expensive care. When the working poor don’t have routine access to a doctor who can help prevent illness, or treat a problem early, people end up extremely ill in the emergency room.
If the Republican majority in Congress were more concerned about spending tax dollars efficiently than worrying about whether poor people pay their fair share, the solution to our spiraling federal health care spending would be obvious. Spend a few dollars now to provide people with insurance rather than spend many dollars later for emergency care.
That’s why former Massachusetts Gov. Mitt Romney, a Republican, launched a program in 2006 to enroll every citizen in a health insurance plan. That Republican-backed program was the model for the Affordable Care Act. The system only works, though, by forcing everyone to sign up for health insurance to spread the risk, including the young and healthy.
Romneycare has boosted Massachusetts’ economy, with not only fewer non-critical emergency department visits, but fewer personal bankruptcies due to medical bills, higher credit scores, less past-due debt and reduced third-party debt collections, according to a 2016 peer-reviewed study published in the American Economic Journal.
The problem, of course, is that Trump and his fellow Republicans have vilified the Affordable Care Act so much that many Americans have lost track of why it was passed.
If this were a battlefield question, politicians would promise to defer to the generals. So let’s take a moment to see what health care’s generals think about how Trump’s actions.
“These benefits help real people every day, and if they are ended, there will be real consequences,” industry trade group America’s Health Insurance Plans and the Blue Cross Blue Shield Association said. “We need constructive solutions that increase consumer choice, lower consumer costs and stabilize local markets. Terminating this critical program will do just the opposite.”
The American Medical Association said it was discouraged by Trump’s actions.
“This most recent action by the administration creates still more uncertainty in the ACA marketplace just as the abbreviated open enrollment period is about to begin, further undermining the law and threatening access to meaningful health insurance coverage for millions of Americans,” the group that represents doctors said in a statement. “Our patients will ultimately pay the price.”
Obamacare has many problems, and I have repeatedly called for Congress to address them. But indirectly repealing Obamacare without replacing it will hurt all Americans.
The best way to lower health care costs, without leaving the poor and ill to die, is to prevent serious health problems, treat illnesses early and provide care in the lowest-cost setting. Trump is trying to force Congress to act, and the best solution is a bipartisan plan that is practical, not ideological.
Unfortunately, there’s no evidence to suggest Congress can pass such a law.