The legendary American philosopher Yogi Berra supposedly said, “If you don’t know where you want to go, you’ll end up someplace else.” That is the story of American health care. We have not decided whether health care is a “right” for all Americans or a “privilege” for those who can pay. It seems that health care is a right for some of the people all of the time and for all of the people some of the time but not for all of the people all of the time. If you find that confusing, then you’re on the right track. We haven’t chosen our destination and we have arrived at a place that confuses and frustrates us.
Health care with little or no out-of-pocket expense is a lifetime right for veterans and for prisoners serving life sentences. I can’t think of any other large groups who have that benefit. Medicare eligibility bestows a permanent right to most health care for those who pay their out-of-pocket share. The rest of us have temporary and partial rights that depend on our employment, wealth, personal choices and luck.
Our national debate should be about who has a right to health care, which elements of health care are included, who will pay for it, and how the cost will be paid. Arguments about whether or how to replace or repeal ObamaCare (the Affordable Care Act) are pointless and counterproductive until we make a firm national decision about whether health care is a right. Where do we want to go?
Critics of ObamaCare point to extremely high insurance premiums in some of the exchanges where insurance is sold to individuals and small groups. Some areas of the country have only one insurance company participating in exchanges. Those problems are real but correctable. They occur in local segments of the healthcare marketplace and are worst in states that resisted ObamaCare by refusing the Medicaid expansion.
Here’s a snapshot of what ObamaCare has accomplished. The annual rate of increase in health care spending (both government and private) was 3.3 percent before ObamaCare. It dropped to 2.7 percent after ObamaCare was implemented. Simultaneously, the number of uninsured Americans decreased by 20 million. That is a picture of success.
President Trump’s promises sound amazingly like President Obama’s. For example, on January 15, 2017 Mr. Trump said, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” …People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.” In the same interview, he claimed that the people covered by Medicaid expansion would continue to have coverage.
A credible replacement for ObamaCare should improve on its performance. But according to the Congressional Budget Office (non-partisan and under Republican supervision) the bill that Republicans tried to rush through congress would have led to 52 million uninsured (4 million more than before ObamaCare). Less thorough analysis from the highly respected Commonwealth Fund agrees. The President and Congressional Republicans dispute the CBO estimates but they have produced no research to support their conclusions. It’s all based on their opinions.
Two principles of ObamaCare are that basic health care is a right for all Americans and that everyone should be required to participate in the cost. Those principles are implemented through the individual mandate to purchase approved coverage along with Medicaid expansion for the very poor. Approved coverage includes services for prevention and early diagnosis of health problems that often lead to premature death, disability and extreme expenses. The Republican plan lacked similar features and would produce more late stage diagnoses of illnesses that were preventable but not curable once they occur.
Because there was no individual mandate in the Republican bill, there would be two options for care of those who don’t pay. Either provide the care and build the cost into the bills of those who do pay or let those who can’t pay suffer or die without care. The individual mandate is better than either of those alternatives.
What should we do? I have asked for a meeting with my (Republican) Congressman. I want to show him the evidence that I’ve found and I want him to show me any evidence that the Republican replacement would produce better results. What will you do? Your answer will come to you after you decisively answer this question, “If the person that I love most in this world is sick and broke, does she /he have a right to health care?” ___________________________________________________________________________
Evaluate performance data from the US and other developed nations HERE using tools developed by the Organization for Economic Cooperation and Development.
This prior column contains links to references and more evidence.
Bob,
Healthcare is both a human right and responsibility. The Supreme Court hamstrung the process by making state Medicaid expansion optional. My brother is one that has felt the effect of the ACA on a small business with a high percentage of increase in premiums and high deductibles. ACA needs improvement but has provided healthcare to many marginalized citizens. State expansion would have helped even more. Hospitals suffer because we are required to provide care and should. Letting the ACA implode is not leadership. Time is on our side to collaborate and improve the ACA. Thanks for reaching out to legislator for rational discussion on cost reduction and strategies moving forward and for being an engaged citizen.
Many Thanks,
Barry
The highly partisan health care insurance debates of the past decade sadly miss a very important point. We live in a time when even a nation as wealthy as the United States cannot afford to provide unlimited health care to every citizen. There are exponentially more care options than were available a generation ago and many of them are expensive. There are also many more lifestyle options that will contribute to how much health care an individual may require. If the question is whether health care is a right or a privilege, the correct answer in my opinion is yes.
The very best we should expect of a national health care system of any kind is to set a basline level of care that is available to all citizens as a right. But that baseline care will not cover everything. Nor should it be so expensive that other important national priorities will be unmet. Beyond that baseline are options that will not be available to everyone. Employers might provide more extensive health care as is the case in some Nordic nations. Those with sufficient wealth can purchase additional insurance or immediate treatments they can afford. The tax system can encourage special medical savings accounts. A two tier solution may seem unfair, but it is no more unfair than life itself. There is simply no ideal solution.
Well said Mike. It’s noteworthy that we spend about 50% more per person than the second highest spending nation in the world. Every other developed nation does exactly what you have suggested AND covers everyone for less than we spend. Canada and UK ,as I recall, spend about half what we do.
When I was a young boy (in about 1946) I was hospitalized for a bad accident and strapped my parents with a bill that they paid off over time. I never heard them complain but if this had happened to a child today there would have been several specialists involved and piles of modern requirements involving advanced equipment, follow up therapy and a much different hospital environment. Actually I recovered completely without everything that would have been done today.
We were all grateful for the level of care that I received but now the profession and the federal and state government would have mandated requirements that did not exist back then. So the level that was available to me was affordable so where do we draw the line? Somehow, and Bob will have to answer what happened, this industry became several times more expensive to treat the same injuries or maladies; even in 1946 dollars. Today the outcomes might be better too.
Let me ask you, who should be able to afford this now? Should a young third grader receive the same treatment for the same injury if his parents cannot buy insurance or pay thousands of dollars; or should the government mandate the best possible care and let the state or the hospitals and professionals pay 90% of the cost?
Growing up prior to the great Society the hospitals and the doctors had to serve at competitive rates. Somewhere along the way the Medical profession found out that companies and the government would guarantee them a high standard of living by supporting the latest standard of treatment for everyone. But former Rep. Tom Delay says, “Only those who can pay deserve the highest cost cure”. That’s Conservative politics spoken by wealthy legislators who feel they earned the best while the constituents are sent to the old fashioned hospitals and the old fashioned doctors.
Let me just say here that President Trump’s remark that it is good to let the ACA and all of it’s patients suffer the loss of Insurance just to make the political point that we need a GOP Plan. The American people will surely see that this is a man with an ego that blinds him to real people’s experiences. It isn’t all the Democrats fault that the ACA is failing and the military is under armed. Remember the “sequester” and all the fights over propping up Obamacare? Are people that dumb?
This comment is well thought out and raises a very important question. does universal coverage mean that everyone gets good basic health care or that everyone is entitled to everything. That DOES require a policy answer, and the second choice simply will not work. The question should be come, how extensive will the basic care be?