A GOP assault on American health care has been turned aside, for now. But major questions have been exposed that will need answering if we as a country are ever to come together over health care. Do we recognize that health care—comprising 17.5 percent of the Gross Domestic Product and trillions of dollars in spending annually— has become so costly, complicated, and critical that each of us, at some point in our lives, must have some assistance from all the rest of the collective us?
In short: Do we believe that health care is a right?
All other civilized countries answered that question long ago in the affirmative and have implemented systems that guarantee everyone living within their borders (or even visitors from places like the USA) a basic package of health care. But we here in the United States still struggle with the world’s most expensive health care system that delivers care to a smaller percentage of its residents than anywhere else and that gets worse outcomes than most other advanced countries.
And it’s because we have a lot of trouble with that basic question. Is it a right, or not?
Let’s not forget: Trumpcare would have stripped tens of millions of Americans of health insurance. It would have hammered Medicaid, by eliminating government guarantees and offering shrinking block grants instead for a program that benefits not just the indigent but also the working poor, the old, the disabled, and the chronically ill. Partisans would have slashed $880 billion in government health care help for those in need, while handing over $600 billion in tax cuts—some of the largest ever—to the wealthy, Big Pharma, medical device makers, and tanning salon operators. Advocates said the GOP also would have sent Medicare reeling.
Partisans who advocated for the Trumpcare bill knew that larger insurance markets, those with young and old accounted for, spread risks wider and more fairly. But they, instead, insisted on the demise of the mandate requiring all Americans to carry health coverage. And throughout the health insurance discussions, Republicans savaged seniors (meaning anyone older than 55 or so) to accord younger, healthier Americans only marginally more affordable coverage. Americans who made $25,000 or so annually, and were too young to qualify yet for Social Security or Medicare were looking at health insurance costing more than half their income.
At the last minute, the partisans got crueler still: They bargained so their radical overhaul of Medicaid would start sooner. They insisted that program participants be subject to humiliations, including re-upping for benefits every few months, and working if they could—a seemingly sensible requirement that flew in the face of the reality of who gets Medicaid. (Hint: Most are too old, too young, or too sick to be employed. Those who can hold jobs can’t because they’re too often the caregivers of last resort. Or they’re already employed. They’re the very definition of the working poor.)
GOP lawmakers also sought to eliminate so-called essential benefits, not only in Trumpcare but even in employer-provided coverage. Which raises the question: Is there some core of health care that we can agree is a right that everyone should be guaranteed, or not?
This might have meant that insurers, as the New York Times put it, would offer plans to cover aromatherapy but not chemotherapy. In the name of (phony) choice and cost efficiency, partisans wanted to toss requirements that insurers covered hospitalization, emergency medical services, and prescription drug benefits. Provisions for potentially costly coverages, which are affordable when included in many plans, would have been stripped away. That would have axed maternity and mental health care, including for those affected by the opioid drug abuse epidemic, had GOP extremists gotten their way. Women and families would have been stranded without help in covering pregnancy and delivery costs that, somewhat inexplicably, can cost tens of thousands of dollars, though they run a fraction of that elsewhere.
With seeming zero policy leadership but many threats from the White House, Republicans in the House and Senate found themselves riven. The so-called Freedom Caucus conservatives pushed for a brutal, smaller AHCA. So-called moderates in the Coverage Caucus scrambled to keep benefits popular with their voters. Every time Speaker Ryan won a vote from one camp with a legislative change, he lost two in the other.
In the end, Republicans failed to deliver on their biggest pledge of seven years. They had delivered dozens of flailing, meaningless ACA repeal votes. But, given the chance, with GOP majorities in Congress and a Republican in the White House, they could not get their numbers together to deliver what they so long promised: better, cheaper, broader health care coverage than Obamacare.
And it’s really because they couldn’t come together over the basic question: Is health care a right, and if so, how much of it should be a right?
As the Trumpcare decision-making came to a boil in the House, two elite researchers, intriguingly, released more information on their path-breaking studies about spiking mortality rates among older whites, both men and women. Their on-going studies on the ravages of “diseases of despair,” including drug and alcohol abuse and suicide, cited key factors of concern. These include dimming job prospects for white men and women with high school educations or less, as well as their upset over a perceived fall in social rank. These white voters, many in rural areas and the South, Rust Belt, and West, also may be succumbing to poorer health and earlier deaths because their anger, unfulfilled expectations, and unhappiness pushes them into social isolation, the researchers said. They contrasted whites’ loneliness, despair, and alienation with stronger, more accepting, and supportive social networks among black Americans—who, due to bias and other factors, may be economically worse off than whites but whose longevity and health is holding steady or on the upswing. To the suffering older, rural, less educated whites, what will the divisive GOP message be now that partisans can’t demonize Obamacare, and can’t take away its benefits? Will this constituency see how they have been exploited?
In my practice, I see the giant harms that patients can suffer while seeking medical services. I know that they not only want justice in the civil system, but they also need what may amount to a lifetime of financial support. American medicine, inarguably, has its high points. It is far too costly, and it’s shameful that medical debt is a leading driver of bankruptcy in this country. Health insurance isn’t the absolute remedy for this. But studies show it is a major factor in allowing ordinary people to access the treatment and drugs they need for better health and longer lives. Obamacare is imperfect, and it would be easy to identify the many ways it could be improved.
But health care, including insurance coverage to help with its accessibility and affordability, should be a right. It’s a collective, societal obligation that we must figure how better to share. It makes no sense to protect the borders of our nation, if too many of our people are sick and dying. The ACA stands, as Speaker Ryan said, as “the law of the land,” for now. But we need to stay like hawks atop our elected officials so partisans like Health and Human Services Secretary Tom Price do not administratively undercut Obamacare. Our health and well-being must be protected, our leaders must return to serving all the people of this country and not to being enslaved by extreme political ideology or theory.