They sometimes say that anticipation is better than the actual event. Real life, in other words, often fails to live up to expectations. The romance will wane, the party will fizzle, the excitement will wear off. From physical laws like the Law of Increasing Entropy to economic laws like the Law of Diminishing Marginal Returns to the principle of Occam’s Razor, it becomes clear that reality is often harsh, and complex systems are doomed to struggle. Enter healthcare in America.
For the last several years, we have had the Affordable Care Act, colloquially known as Obamacare. The controversial legislation forced health insurance companies to accept all applicants and provide more services than they had provided previously. In exchange, the insurers got lots more guaranteed customers through the law’s individual mandate, which forced citizens to purchase health insurance or pay a tax. For low-income citizens, government subsidies helped pay for health insurance.
Conservatives bashed the ACA as big government and particularly loathed the individual mandate. Liberals complained that the ACA did not provide enough help for the poor and did not force insurers to provide enough coverage. Few were happy, but most would begrudgingly admit that millions of previously-uninsured Americans gained some form of healthcare coverage. Republicans vowed, from day one, to repeal the law and replace it with something “better.”
Well, after a long delay, the Republican substitute for the ACA has been unveiled… and nobody is happy about it. The Obamacare replacement bill, dubbed AHCA (for American Health Care Act), was finally revealed by Republicans in the House of Representatives after weeks of anxiety. U.S. Senator Rand Paul (R-KY), who had previously made waves by storming over to the House and demanding to see the bill, has declared it “dead on arrival.” Conservatives and liberals are already bashing AHCA, with conservatives calling it “Obamacare Lite,” and liberals claiming that millions of citizens will lose coverage.
Moderate Republicans are also in opposition due to AHCA’s paring back of Medicaid. Under Obamacare, states had the option to get expanded Medicaid funding. Some red states chose to accept Obamacare and its additional federal money, which means that those constituents now expect that level of government service and will vote against any elected official who tries to scale it back. It was one thing for the GOP to gripe about Obamacare and its many struggles, but to actually vote to repeal it is a whole different beast.
The American Health Care Act is dead on arrival because it fails on virtually all fronts compared to its predecessor.
First of all, AHCA has been attacked by conservatives due to its use of tax credits as insurance subsidies. Free-marketers complain that this is simply another government entitlement program, doling out money. Pro-business conservatives are also unhappy that government restrictions on insurance providers continue: Just like under Obamacare, health insurance companies are not allowed to deny coverage due to pre-existing conditions.
More outrage comes from conservative Republicans regarding the individual mandate concept. Allegedly, the demand that all citizens have health insurance continues, but in a different form. Instead of paying a tax to the government for failing to maintain health insurance, citizens will have to pay a 30 percent higher insurance premium for a year after signing up. It’s a “tax” that goes to the health insurance company.
House Republicans appear to have generated ample scorn from both sides of the political aisle by committing the cardinal sin of indecisiveness: Trying to have it both ways and refusing to take a stand. To avoid the anger of the left, they kept several popular Obamacare components, including some form of subsidies and the requirement that insurers accept pre-existing conditions. To avoid the anger of the right, they chose to scale back Medicaid spending and eventually hand it entirely over to the states, as well as defunding Planned Parenthood.
As a result of this waffling, the American Health Care Act has lost the respect of most observers. More importantly, it has raised the question of whether or not there can be workable conservative healthcare reform. With every other industrialized nation providing universal health care, the United States remains the sole privatized holdout. The Republican Party’s agonized struggles to keep all groups happy with a pro-privatized healthcare plan reveals why single pay is so popular globally.
Simply put: You cannot achieve adequate care for all citizens without single-payer health care. The liberals pushed through Obamacare because the free market was not providing adequate coverage for enough citizens. The conservatives are deluding themselves if they think the “free market” will do any better. Profit-seeking healthcare providers care about maximizing profit, not maximizing coverage. Many citizens are not profitable to cover, which is a plain hard fact.
Without government regulations and subsidies, many Americans will not receive health insurance because they cost health insurance corporations more money than they will ever pay in premiums. Unless Republicans are willing to admit that they are okay with some people dying on the streets of our cities because they cannot afford healthcare, their privatization policies will be insufficient. The only way to provide adequate healthcare for all citizens is to make basic healthcare as universal as K-12 public education.
Today, any child in America has the right to receive a comprehensive public education. It may not be pretty, but it works. It is doable. And most do not complain: Some 91 percent of U.S. parents enroll their children in public school. If we can do that, we can definitely provide basic medical care for all citizens.
With the American Care Act dead on arrival and loathed by both liberals and conservatives, perhaps the vacuum left by its implosion will help leaders of both parties see the light and accept what every single other developed nation has.