The promise, at least by The Donald, to (1) not let previous conditions be the cause of rejection of insurance, (2) that the 20 million or so people that got coverage as a result of the ACA will still be covered and (3) letting a young adult stay on their parents policy until the age of 26 will part of the new, cheaper and better plan that the Republicans will submit.
The biggest reason the ACA fell on it's face was simply that the young, healthy folks didn't sign up in droves. The only way to provide the lowest cost insurance for the masses is to spread the burden on paying for it to a large base of primarily healthy people that don't require much in the way of treatment. You need a large base of people who are paying in to the system much more than they're taking out of it.
The problem is, and will remain, that the Congress, especially the Republicans, want universal health care without instituting Universal Health care. They believe, by some fancy twist of their imagination, that they can achieve universal health care using the private sector. They spout a mantra of freedom of choice. They believe that if you presented the market place with a free market in the medical fields, the cost would go down due to competition and all would be right with the world.
To large extent that would be true. If the market were actually free and the consumer was free to choose any insurance plan from any locale and that the insurance companies could propose any plan from the bare minimum catastrophic only type with a large range of deductibles, to full comprehensive coverage and anything in between. But, if the government steps in and dictates conditions that private insurance companies have to meet, as the ACA did, then the savings would largely fly out the window. When you dictate that an insurance company can't turn down a applicant because of previous conditions or they have to carry a young adult on their parents policy, then they have no choice but to anti up their rates to cover the significant costs associated with those requirements. After all insurance companies are in the business to make money. They are not philanthropic organizations.
Consumers are not exactly dummies. The smart thing, under these conditions, is to buy limited coverage, or none at all, when you're young and healthy and then to buy or switch to more comprehensive policy if you come down with something bad. So the only way to spread the costs is make some level of insurance coverage mandatory for every body. That, by its nature will kill any free market idea associated with health care. Sound familiar? Obama tried to get around this problem by forcing a "tax" on those that didn't purchase the minimum insurance as dictated by the law. I'm not sure what the present bill before congress will end up imposing, but it has to somehow rope in the total population or it will fall on it's face just like the ACA did.
The Republicans love the idea of using tax credits to help lower income people buy private insurance. No matter how you look at it, this is another entitlement that would put into law if enacted. Of course if the tax credit is applied to taxes owed, there won't be much impact on the 40 percent of lower income people anyway; they don't pay taxes.
The other favorite among the conservative ranks is the Medical Savings Account. That really is a great idea if you are part of the middle class, which does cover a great swath of the American citizenry. But, if you happen to be in the lower third of income earners, then you don't have the resources to set money aside for medical purposes.
The idea seems to be that if they open the market, which by the way isn't happening with the present version of the plan, that will allow more people to buy private insurance and the lowest wage earners and unemployed will be directly subsidized by the government in such a way that they can purchase some form of insurance. Sound familiar. Think California Cares, which pays so little to the doctors that many of them will not participate in the plan.
The other mantra sung by the conservatives is that they don't want some government bureaucrat deciding about what medical treatment that will be allowed and where the coverage is applied. But, wait a minute. If you carry any kind of private insurance then you already have a bureaucrat deciding health care issues for you. They just work for the insurance company instead of for the government. And, those bureaucrats have a profit motive when considering whether to pay for some treatment that you might need.
Private insurance also limits the doctors you are allowed to see and sometimes the medical facilities that you can use, depending on the type of insurance. HMO's are a big factor in private insurance participation and they are generally very restrictive in where and by whom you can get medical treatment.
If you want to review the current health care in the USA I would refer you to my Blog of January 2016, "Health Care in the United States". It is clear that the current system we have isn't any thing to be held up as a model. We have the highest infant mortality rate, the shortest average life span and rank behind such countries as Singapore and Morocco by the World Health Organization. The ranking at the time is a paltry 37th in health care by that organization.
The argument is advanced that in those countries with Universal Health Care systems, that the wait to see a doctor is long, much longer than in the US. But, have you tried to get to see your doctor in a short time lately? In fact, the timeliness of care in America is about average when compared to the 11 wealthiest countries i.e. England, Germany, Canada, etc. All of them having some form of universal health care. Canada however, with a one payer system, was ranked last in that category. The following chart shows the breakdown of the various categories that were used to judge the rankings among the wealthier nations.
We spend more per capita and get less than any of the 11th wealthiest countries. So why are we trying to defend our present system so vigorously? Good question.
The Republicans face a real problem. As far as I can see, the plan put forth by the Republicans doesn't do much for the very people who were Trumps biggest supports in the last election. As bad as Obama Care was, this plan may actually be worse for the mid-west worker who is hurting because of a lot of reasons. The disgust with the ACA was one of the main things that swept the Republicans into office in the last two elections. If the establishment Republicans don't do something better than what they seem to be doing, they may, and probably will, find themselves on the street in two years.
Medical care has become a major issue to the citizens of this country. They are serious about wanting something done. If the politicians continue to evade a comprehensive plan that will assure medical care for all Americans, I think they may not be in office very long.
We'll see what happens over the next few months and what the fallout will be. I predict disaster myself. But, I've been wrong before.
