Image by Just some dust (License CC BY-SA 2.0)
There’s no way to begin this discussion without blowing some people’s minds. Obamacare doesn’t exist. There is no such thing. The health care reform that is currently providing millions with insurance is called the Affordable Care Act.
That rebranding wasn’t done by Democrats, it was a ploy by the GOP – trying to sink the law by equating it with a Democratic President. To this day, the ACA remains broadly popular. ‘Obamacare’ is more divisive – even though it’s the same thing! There are people who want to repeal Obamacare who don’t even realize they’d be taking away their own insurance.
President Obama began his term with fairly high approval ratings and Democrats in control of the House and Senate. He made health care reform a top priority, which it damn well should be. America has the most broken health care system in the western world, because literally every other major western economy has universal health care. Find one that doesn’t. I dare you. Universal health care provides better outcomes for less money, per person. This is why the developed world came to the unanimous (except for us) conclusion that it’s better.
“If the only way to avoid catastrophe is letting Donald put his name on something someone else built, yet again, then we have to be the grown ups here. God knows, adults in government are in short supply these days”
Why is universal coverage so much better? Because though we do have a system that requires dying people be fully cared for, even if they’re uninsured, and though we can’t turn the desperately ill away from hospitals, by law, what we deny many people is preventative or early-illness care. We make them wait until they’re dying.
Taking care of dying people is MUCH more expensive than treating those people when their illnesses are still treatable. So, without coverage, you spend more money, and people who might have been cured with earlier treatment, die needlessly. That doesn’t seem great to me. Broadening insurance coverage saves money and lives. And there are 20 million Americans covered under the ACA.
It is shocking how many people who support repealing ‘Obamacare’ also support the individual planks of the ACA. Individual planks such as providing Health Care for people with preexisting conditions, giving subsidies to working people who can’t afford insurance without them, and allowing kids to stay on their parents’ plans until age 26. All overwhelmingly popular.
The ONLY unpopular plank is the individual mandate, which is not a government mandate that everyone must buy insurance. It applies only to people making enough money that they ‘could’ buy insurance if they chose to, and if they choose not, they’ll pay a small penalty. This is intended to encourage more healthy people to buy subsidized insurance instead of betting they won’t get sick. It gets more people cheaper, more effective preventative care, and cuts down on the ‘free rider’ problem of people who wait till the situation is life or death. It saves lives and prevents bankruptcies over health issues. It’s also one of the foundations of Romneycare, proposed by the conservative think tank Heritage Foundation, and widely supported by Republicans until a Democratic President was proposing it.
The benefits of ‘Obamacare’ are popular, even with Republican voters, until you get to the market-based provision that helps pay for the rest – the mandate. GOP voters are on board with getting coverage even if they’ve been sick, and keeping their young adult kids on their plans, but they revolt over the provision that makes it possible without massive government cash – the mandate. There is NO WAY to keep the popular benefits and eliminate the mandate without pumping billions of federal dollars into the system. That’s math. It’s basic common sense. It’s why the GOP has spent most of a decade passing ‘Repeal Obamacare’ legislation but still don’t have a plan for ‘replace’.
The ACA isn’t perfect. It’s just the best option that devoted, well-meaning experts could get through Congress. They had to kill the Public Option to get it passed, and that was a centerpiece of the law that would have helped control costs for everybody. But it was a little too close to the government health care every other western country developed, so it had to go. The medicaid expansion went from mandatory to opt-in, leaving millions of red state voters cut off from benefits. But it offers 20 million people insurance while saving lives, and money, at the same time!
If there were easy solutions the ACA didn’t adopt because of Dem politics and flawed ideology, as the GOP has claimed, the GOP would use them for its replacement plan. Shockingly, after years of complaining, they still haven’t offered an alternative.
After gaining control of the entire federal government, a consensus was forming recently around ‘Repeal and Delay.’ Delay, potentially, forever. If they had no plan after 6 years of repeal votes, there was little reason to think they’d suddenly figure it out once the old law covering 20 million people was gone. A combination of freaked out constituents afraid of dying, and a GOP President promising better coverage for more people for less money (and unicorns and rainbows and warm hugs), got them to back off. They’re back on the Repeal and Replace bandwagon, only this time, ‘Replace’ has to mean something.
The best case scenario is that the GOP responds by finally doing what Dems have been requesting for years – addressing the flaws by amending the law, based on what we’ve learned since it was passed. If that means tweaking the ACA while pretending it’s been ‘replaced’, then letting them call it ‘Trumpcare,’ so be it. That’s better than crashing our Healthcare system.
If the only way to avoid catastrophe is letting Donald put his name on something someone else built, yet again, then we have to be the grown ups here. God knows, adults in government are in short supply these days. Personally, I would sign on for that, because I work in health care and I don’t want to see innocent people lose their insurance, some of whom will die, over GOP ideological bullshit. But I’m 99% certain that the GOP is going to offer ‘Obamacare’-light. It will NOT save money. It WILL cost lives. And its primary victims will be the working class and underemployed. I truly hope I’m wrong, but it’s not looking good.
[Update for late-breaking news – Yesterday, the GOP released a draft health care proposal. Projected costs and coverage levels are not offered. The plan itself is still vague, but more detailed than anything offered over the seven years the GOP has been trying to ‘repeal and replace’ the ACA. Now that it’s put-up-or-shut-up time, and it’s too late for voters to evaluate the plan over the course of an election, they put something out that seems like Obamacare-light. Because it repeals the individual mandate (designed to help keep costs sustainable by disincentivizing people from waiting until they got sick to buy insurance – a linchpin of the law), while keeping provisions like young folks staying on their parent’s coverage until they’re 26, and banning exclusion of coverage for people with prexisting conditions, it seems certain that it will cost more, yet cover fewer. This proposal could be titled the ‘Have Your Cake and Eat It Too’ reform. The GOP often criticizes Dems for supposedly ‘giving stuff away’ without paying for it. Yet they’re promising to keep the popular benefits while abolishing the mechanism that makes them affordable. Yes kids, you can have ice cream for dessert, but only if you finish all of your cocaine. This is fiscal conservatism? Forget the money from the federal budget, we can go further into debt – this proposal, as written, looks like it would crash the insurance market for EVERYONE! But we don’t have those details yet, because the GOP has been holding us in suspense for most of a decade, promising us the moon without ever laying out a path to get there. This draft is only a start. And it isn’t a very good one. I stand by everything I wrote previously. They still don’t have a plan.]
Travis Hepburn was a Top 25-ranked debater on a National Championship-winning team at Creighton University. He currently manages an Assisted Living Facility for the mentally ill. Politics and policy have remained an unhealthy fixation for him for over 20 years.