Trouble Ahead: Thoughts on Health Care
Ugh!!! Here’s the Congressional Budget Office’s Cost Estimate for H.R. 1628, the Senate version of the so-called Better Care Reconciliation Act of 2017. Dense, but I read it. Characterization? “Despicable,” but only because I must be civil.
Some random thoughts:
Process. When you design a plan secretly, you’ll get a bad plan. Always, but especially when you are dealing with health care, which involves almost 20% of the American economy. The Affordable Care Act process involved 100+ hearings. Tons of input from stakeholders. The Senate Finance Committee’s bipartisan Gang of Six worked for months, as well. That process helped, even though the three Rs voted no on the bill in the end. And—in the world of trial lawyers, we call it “drawing the sting”—save Nancy Pelosi’s dumb comment for sillier places. She made it at the end, about some amendments which did not change the essence of the ACA.
And about amendments? Bad idea, in a situation like this one. A well-crafted bill—which this one isn’t, by a long shot—suffers badly when random changes get adopted at the end, just as a custom home, well-designed, gets worse with last minute changes. And just as change orders don’t solve for bad design, amendments won’t help here.
The Tax Cut. When you design a system to replace the ACA and start with cutting taxes by roughly $750,000,000,000 over 10 years, you’ll end up with something like this monstrosity. Simply, when you eliminate tens of billions of available dollars of annual spending, you don’t have anything left to insure the part of the 22,000,000 people who depend on Medicaid. And when you strip away money for subsidies and don’t want insurance premiums to rise, you have to let states eliminate the 10 Essential Health Benefits, which will leave millions without real coverage. Etc. So, when people—POTUS and his minions—talk about failed Obamacare, their blather matters not at all because their replacement offers nothing to fix any problems.
Poor People. If anyone doesn’t think some of our leaders hate poor people in the abstract—not hard working Cousin John, who can’t catch a break, but Them—they’re not paying attention. Replacing Obamacare has as its central theme putting a whoop-ass on anyone who struggles. (Read the CBO report.) And there’s no shyness on the issue. Here is a sampler:
Mick Mulvaney, head of the Office of Management and Budget, telling us we shouldn’t “take care of the person who sits at home, eats poorly and gets diabetes.” As if we can decide who gets and doesn’t. And, by the way, who decides?
Congressman Roger Marshall (R-Kan.), an obstetrician before he went to Congress, who believes “there is a group of people that just don’t want health care and aren’t going to take care of themselves.” (Prefatory to that observation, the man said “Just like Jesus said, ‘The poor will always be with us,’” leaving out the rest of Deuteronomy 15:11, which reads: “Therefore, I command you, ‘You shall open wide your hand to your brother, to the needy and to the poor, in your land.’”*)
Congressman Mo Brooks (R-Ala.), who thinks some people don’t deserve health care because they haven’t lived “good lives.” By what measure, Mo? And, again, who decides?
Emergency Rooms and Hospitals. Congressman Ron DeSantis (R-Fla.) has suggested emergency rooms as a treatment facility for people without insurance, stating: “If people really need it, they show up to the emergency room, they do get care, it just gets passed on to other folks.”** Some solution, huh? Take a system designed only for emergencies, turn it into a primary care facility, burden the hospitals with uncompensated care, and let us all pay. And from where does this idea come? The fact that, before the ACA, that’s where poor people got their care. Why? Because. They. Had No. Other. Options.***
Regarding hospitals generally, the Rs pay hospital economics no never mind, evidently, for they seem to believe hospitals will exist no matter what. No way! Hospitals struggle. All of them, but especially the ones in rural, underserved and often underpopulated areas. Take away 22,000,000 covered people and watch what happens. By the way, hospitals are egalitarian institutions. When the hospital goes bankrupt, poor and rich people are S.O.o.L.
Keeping a Promise. I keep hearing R pols talk about their commitment to repeal and replace Obamacare. A sacred vow, I guess, and consequences be damned. Smart people listen and learn, and act accordingly. No teaching these pols. We promised, and we deliver!
Time will tell, but be sure about one thing: this plan, if it makes its way out of the House and Senate and the president signs it, will destroy the American health care delivery system. Maybe, just maybe, we need total destruction to end up with a better way, but lots and lots of people will suffer during the chaos.
*I sweated for a bit the link between Jesus and Deuteronomy. The Jesuits saved me.
**This nincompoop raised the ER solution in the context of a question about cancer treatment for someone who had exhausted lifetime limits.
***My very few Wingnut friends love to spout off about how poor people only go to the ER. They also complain about ER wait times. Nothing to see here, of course.