After months of waiting, we now have the Republicans’ answer to the health care crisis. They hope to repeal Obamacare by eliminating the individual participation mandate, and offer subsidies to help people afford health insurance.
While this may make health insurance premiums more affordable for some, it is not nearly the health-care fix that America needs. In fact, it is really just a Republican version of Obamacare—an attempt to increase the number of people who have access to health insurance.
The biggest problem with this is that modern health insurance is not the equivalent of having health-care. Having health insurance once meant that you had access to the care you needed, but today, that is not necessarily the case. The inevitable high deductibles associated with newer policies prevent many people from receiving care. In addition, less complete coverage associated with these less expensive policies may mean that many Americans will go without the care they need, or still have to pay for it themselves, despite having insurance.
As with Obamacare, this may change the health-care winners and losers, and the nature of the problems they 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 if high deductibles keep you from accessing the care you need, or if it just so happens that your narrow coverage doesn’t cover necessary care when you need it, you may lose big. Tax credits may similarly increase the affordability of health insurance for some, but the same arguments apply.
One of the more important lessons we can derive from the Obamacare era is that if we require the commercial health insurance industry to cover everyone, and to provide anything approaching comprehensive care, they find it difficult, by their own report, to remain profitable, or to provide insurance with affordable premiums. In other words, the commercial, for-profit insurance companies are unable to provide the comprehensive solution that America needs.
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.
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.
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.
If we want to make actual progress, rather than continue to push the ball around, our government must guarantee these 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 these Republicans will be those heroes.
But, just like with Obamacare, 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.