Category: Health

Let’s all remember how we got here.

Before Obamacare, before the Tea Party, before the election of Barack Obama, we had a healthcare crisis. Premiums were skyrocketing. Insurance companies were cutting off access to expensive procedures. The bottom line was: health insurance as we’d enjoyed it for decades was going away with nothing left in it’s wake. Nobody disagreed with this assessment.

Ross Perot once famously quipped of Social Security, “Social Security made sense when the age to collect ws 65 and the average person lived to be 60.” Whatever you think of his or anyone else’s policy prescriptions for SS, the truth of this statement was pretty undeniable. As our lifespans lengthen, it gets more and more expensive to take care of each other.

And as people lost insurance, they didn’t lose their diseases. Which meant people ended up in the most expensive part of the hospital – the Emergency Room – instead of taking care of issues early with a primary care physician. Because hospitals have an ethical responsibility to fix broken people, the cost of those emergency visits was necessarily passed on to the rest of us.

Neither are cost and advanced age the only issues. In the last few decades, we’ve seen a shocking rise in the rate of Non-Communicable Diseases (NCDs) such as diabetes, Crohn’s disease and heart disease. It isn’t just that we’re getting older: we’re getting sicker when we’re young. All of this adds up to a pretty incredible burden on a health insurance system. Especially one that is market- and profit-driven.

Obamacare

Obamacare sought to address the fundamental issues of the health insurance industry by bringing more people into the system. Similar to Social Security, the more participants are paying into the system, the more money there is to pay for the more expensive needs of other members. Better still, by bringing people into the health insurance system and giving them access to preventative care, Obamacare sought to lower the overall cost of taking care of sick people.

In exchange for new business and more profit, Obamacare required insurers to adhere to a list of demands like insuring people regardless of their “pre-existing conditions,” which is just a way of saying you know they have potentially expensive issues, but you’re going to cover them anyway. In fact, Obamacare eliminated “insurance underwriting,” which means insurance companies are not allowed to demand a complete medical history to cover you.

Much of what Obamacare was meant to address did work. We got 24m more Americans covered by health care. Insurance companies honored the commitment to cover all comers. But the largest concern of most Middle Americans, the cost, didn’t stop rising. It rose at a much slower pace, but that’s cold comfort to someone already feeling the pinch of rising costs.

I would argue that, given that a big component of Obamacare was wrestling with pre-existing conditions and lack of preventative care, there probably was never a chance that the cost curve could be reversed overnight. Or even in seven years. Sick people don’t stop being sick. A lifetime lack of care doesn’t get that much better right away. Nevertheless, Obamacare promised lower healthcare costs and didn’t deliver fast enough for America’s patience, it seems.

Because if President Obama ran on the promise of Obamacare, to the extent that President Trump’s campaign was “about” anything, it was once again the promise of way better healthcare.

The AHCA

So Republicans are tasked with reversing Obamacare. And they’re tasked with creating a new system that allows health insurance to be a profitable business at a lower cost, because the one thing Obamacare didn’t deliver on was lowered premiums.

Go back and reread the first few paras of this article. Our healthcare crisis is a logical conclusion of living longer and getting sicker as a species. It wasn’t an institutional crisis – it wasn’t that insurance companies were changing policy without reason. We have a genuine crisis of a demand for coverage that drives costs through the roof. Lowering costs, then, can only mean one thing: lowering demand by cutting off access.

If we’re not going to stick it out with Obamacare, then as harsh and cruel as the AHCA is, it is exactly what is necessary. If we’re not going to do our best to increase participation, our only other alternative is to make what insurance companies previously tried to do quietly a matter of national health care policy. We need to decrease demand.

Cruelty isn’t a bug: it’s a feature.

The cruelty of the AHCA is hard to take in. The expansive ways in which Republicans chose – completely on their own – to take a sledgehammer to the very idea of health insurance is breathtaking. As the ACLU points out, the AHCA basically makes being a woman a pre-existing condition. VoteVets points out that it bumps millions of veterans out of the health insurance markets by denying them the tax credits “granted” to the rest of us and shunts them into an already overwhelmed VA system.

Cruel though these things may be, supply and demand economics requires that either there is way more supply or way less demand. No other thing will reduce costs. Democrats essentially tried to buoy supply by increasing participation and in so doing, raise the capital required to expand the supply side. Republicans have now fully bought into the idea that slashing demand will work.

And the worst part of all this is, again, that sick people don’t stop being sick because they don’t have health care. They’re going right back to the emergency rooms. And they’re going to jack up the price of health care. And – brace yourselves – there will be no cost savings. There will be no lowered premiums. And we know this, because we already lived through this once.

But Republicans have spent eight years decrying Obamacare. They can’t just walk away now. And there is absolutely no way of “improving” this bill. The Senate will not be our saviors. Because to alter this bill is self-defeating. The only thing to do is let it die. Do we believe Republicans have the strength to do that alone? Or should we help them come to the logical conclusion?