The push to “Repeal and _______ Obamacare” has taken on an air of near religious fervor among the Republicans.
The question on everyone’s minds at this time is the _______ of the “Repeal and _______ Obamacare” movement. There are some indications as to what may constitute the ________. It appears to be a host of ideas long discussed by Republicans.
I would like to suggest a framework we can use to evaluate any of these potential proposed changes in the health-care landscape. If we want health-care in America to be fixed once and for all, we must focus most on the needs of American patients, who have in the past and continue to be the ones who suffer the most in a failing system.
From the perspective of the patient, the standard by which the success or failure of health-care reform in America should be measured is this:
All patients need a firm, reasonable, and affordable cap on health-care expenditures in a given year.
All patients need full access to a nationally-determined comprehensive, basket of necessary medical goods and services.
All patients and medical professionals need drastic administrative and bureaucratic simplification.
Prior to Obamacare, too many American patients suffered mightily because there were no reasonable limits on the costs of their medical care, and because they could not get access to the care they needed. Our failure then was a national disgrace. In the era of Obamacare, while many more people were able to obtain health insurance, their remained far too many people who suffered because their health-care costs were too great, and who still could not obtain the care they needed (even with insurance). This remained our national disgrace. If we want to make actual progress, rather than continue to push the ball around, our government must guarantee these two concepts as the foundation of a health-care overhaul. The administration that accomplishes this will go down in history as national heroes. It does not appear that the Republicans will be those heroes.
At the time of this writing we know a substantial amount about what the Republican leadership has in mind:
Repeal Obamacare by eliminating the individual and employer participation mandates, and dropping minimum health insurance coverage standards. This will likely enable health insurers to offer insurance with less expensive premiums, but that will be at the expense of high deductibles and less coverage.
As with Obamacare, this may change the health-care winners and losers, and the nature of the problems people experience, but it will not eliminate them. If you are able to purchase more affordable insurance and you are lucky enough to have health issues covered by your policy, you may be a winner. But high deductibles keep some people from accessing the care they need, and if it just so happens that your narrow coverage doesn’t cover necessary care when you need it, you may lose big.
Use of tax credits to help make health insurance more affordable and health savings accounts (HSAs) to give Americans more flexibility and control over how their health-care dollars are spent.
Tax credits may increase the affordability of health insurance for some, but again, high deductibles and narrow coverage may still keep people from accessing the care they need. And it is doubtful that most Americans, especially those with lower incomes, will be able to save enough in their HSAs to make a significant dent in a sizable health-care bill.
So, once again, there are most likely to be winners and losers under such a plan.
Moving control of Medicaid away from the federal government, allowing the states more flexibility and control over how Medicaid dollars are spent.
This is clearly a mixed bag. Some states have more resources and administrative competencies than others. Once again, there will be winners and losers.
This is a set of ideas that certainly reflect Republican values. And it may make health insurance more affordable, but it is not the guarantee that America needs. There are still no specific limits on out-of-pocket expenses, and there is no guarantee that necessary care will be covered. And there is nothing yet to indicate whether patients or health care professionals will be freed from today’s bureaucratic nightmare. The best that can be said is that, once again, the winners and the losers may change, and the nature of the failures will likely be different, but still, a large number of Americans will continue to suffer and die at the hands of our health-care system. As it was in the years prior to Obamacare, and as it was in the era of Obamacare, it is most likely that health-care will continue to be a source of national disgrace, and another opportunity to fix what is broken will be wasted.