What is the future of our health care?

On March 24, the signature legislative goal of the Trump administration and the Republican Congress went down to defeat. The American Health Care Act was pulled from the floor and it was decided to forget about the Republican pledge to repeal and replace Obamacare for the foreseeable future. The Trump administration and speaker Paul Ryan have both suffered a major defeat. For his part, Trump has moved on and washed his hands of health care.

Ezra Klein, formerly of the Washington Post, published an article on Vox, just prior to the first scheduled vote on the Republican health care bill, which was postponed. Klein provides a devastating critique of the health care bill and compares it to the failure of the Iraq War under President George W. Bush.

He points out that there was a disconnect between what the bill did and what Trump and Republicans were saying that the bill would do. The bill itself dovetailed with Republican philosophy. Republicans don’t believe the government should provide poor people with insurance. If they do provide it, it should not be very good. They could make that philosophical argument, but instead they criticize Obamacare for costing too much and not insuring everybody.  

Klein compares this dishonesty with the Iraq War which we were told was to remove weapons of mass destruction that didn’t exist. We are now told that the new health care plan will cover everyone with good insurance that they can afford to use. Klein says unequivocally that “in both cases, they were lied to.”

The Congressional Budget Office estimates that 24 million people would eventually lose their insurance. Insurers would create plans with higher deductibles and less coverage. Limited tax credits would cause consumers to buy less beneficial policies. What is misleading is that this bill does exactly what Republicans want it to do, but they are not telling the people that.

Klein also notes that Trump and Republicans have criticized the Obamacare process. It was rushed through the Congress with no one having a chance to understand the bill. Yet from start to finish the Obamacare bill took about nine months to complete and went through extensive hearings and amendments. In contrast, the AHCA was to be passed through the House 20 days after it was introduced, and through the Senate within 30 days. No effort was made to include Democrats.

Republicans insisted that what was wrong with Obamacare is they moved too fast, ignored public opinion, dismissed congressional opposition, and ended up with a bad bill because of it. Republicans have done everything they criticized Democrats for and as Klein writes, “supercharged it.”

According to Klein, the reason Republicans have moved in this way is they feel they need to move fast or they will fail. Based on results they apparently didn’t move fast enough. Klein notes that “[t]his is the cost of constructing a plan that people will like less as they understand it more.”

Klein makes one final point. Republicans say that if you are concerned about the bill, don’t worry, phase two and phase three of the plan will come later and make it a great bill. Klein compares this idea to the notion put forth in the Iraq War that American troops will be greeted as liberators by Iraqis.

There is a danger and a hope at this point. The danger is that the Trump administration, specifically through Tom Price, the Health and Human Services Secretary, will do what they can with the powers they have to destroy Obamacare. They have already acted to eliminate the penalty individuals would incur for not buying insurance. This action will seriously impact the number of people who opt into the program and thus force premiums up. Price has additional powers under the act which can cause significant mischief. Such behavior would be irresponsible and fail to consider the harm it would do to individuals who need health care.

The hope is that adult members of both parties will put politics aside and work to craft legislation that would actually help people, and put the health care system on a sustainable trajectory. Then, maybe we could talk, not about Obamacare or Trump Care, but American health care.

Is that too much to ask? To ask that the elected representatives in Washington actually try to help the people they were elected to serve?

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