June 22, 2017
Finding a way to ensure that every American has access to quality, affordable health care is a job that really needs to get done.
While the turmoil continues over the investigation into Russian election meddling and spreads to possible obstruction of justice and financial misdeeds, the Senate is pushing to pass its version of the American Health Care Act, which purports to get that job done with a “repeal and replace of Obamacare.”
Unlike their counterparts in the House, who went to the Rose Garden for beers and celebration when they moved forward a plan to pull insurance away from 23 million Americans and slash Medicaid to the bone, senators don't seem very proud of what they are doing. They aren't trotting out amazing proposal after amazing proposal to take the spotlight off the dumpster fire and shine it on their outstanding policymaking.
Rather they are hiding in the shadows, hoping to push through a secret bill that will likely not meet with universal accolades. In fact, the details released so far show it falls far short of actually fixing what needs to be fixed about the Affordable Care Act, leaves millions of Americans in uncertainty and leaves the country's most vulnerable to fend for themselves.
The truth is our health care system been failing too many people for too many years, and Americans are getting pretty fed up with it. The problems we are facing today didn't start with the Affordable Care Act. The framework of our health care system and the strings that tie it to "work" are not based in the ideology of today that suggests if you aren't working and you get sick, you just get well or die. You are not "entitled" to see a doctor. That is a privilege for the independently wealthy and those who have employers that provide insurance.
Rather, the employer-paid system was born in the wage freeze of World War II. In trying to hold down spiraling costs and inflation as a result of a critical shortage of labor at the end of the war, the government created a "temporary" tax break for employers who provided health insurance.
Employers soon grew to love the tax break and to see providing better and better benefits as a way to attract and retain employees. And thus was born the American employer-linked health care system.
For a time, it worked. In post-World War II, when factories cranked up to meet pent-up demand after years of rationing and want, unemployment was very low, and employees were loyal to the where company they worked, spending an entire career in one company. They were rewarded with a retirement pension, a gold watch and a lifetime of health care.
American leaders considered themselves much better at solving this basic societal need with a "market-based" system rather than the "socialist" plans being crafted in other Western-style democracies, where the government became the single payer for health care and included everyone, young, old, employed or not.
Over time, things changed. And the employer-based model started to not work so well. By the 1980s, spiraling costs led to the formation of Health Maintenance Organizations that offered "managed care" with a stated goal of making Americans healthier and a robust goal of reducing costs.
By the 1990s, there was a growing crisis that the Clinton administration tried — and failed — to address. By 2008, there were 43 million Americans with no insurance coverage, denied for pre-existing conditions (as defined by insurance companies), for aging off their parents' policies while still full-time students, or for simply being unable to afford the premiums on individual policies or even those offered by their employer.
This is the problem the ACA tackled with heavy Republican objection. The implementation of the law was shaky, and the rollout of competitive marketplace exchanges was fraught with technology problems. Some parts of the legislation have worked — tens of millions more people have insurance coverage. But costs are still going up, and some people have less choice about plans and doctors. Most recently, with the future of the rules put in place by the law, insurance companies are faced with extreme uncertainty about what the future holds and are pulling back from offering plans.
So, now comes the American Health Care Act, which has passed the House and is slowly seeping under locked doors in the Senate. So far, the bill would mostly put us back to 2008, with most of the problems that existed then. Some of the more conservative members would prefer to go back much, much further — more like back to the 1930s, when everybody was on his own and a single provider, Blue Cross and Blue Shield, offered policies to help you out if you hit catastrophic expenses.
The problem is that in 1936 there were no MRIs or PET scanners; no genetic marker therapy for Stage 4 cancer; no high-powered (and highly advertised) drugs; no heart, liver, kidney or lung transplants; no knee, ankle or shoulder replacement surgeries; and hospitals were where you went to die.
The reality is the ever-increasing deductibles on plans have put us back to every person "pays the routine stuff," and policies only kick in when expenses have become catastrophic. But it hasn't resulted in reasonable premiums. In fact, premiums are higher than ever.
It's time for all members of Congress to get to work on this. Democrats have to do more than just vote "no" on the AHCA. They need to craft legislation that actually solves problems and at least present a bill in committee. Yes, it might just be shot down. But it is important to think long and hard about solutions and craft serious legislation. That has to be done by both parties, working together.
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