A plea to Republican politicians to prevent an Orwellian health care system
The news concerning Arizona senator John McCain is extremely sad for his family and friends. His glioblastoma is particularly aggressive, but McCain is a fighter, and we can only wish him well during his treatment. As a result, his ability to be present in Washington may be limited dependent upon his treatment schedule. Unfortunately, this adds further complication to the dysfunction in Washington among Republicans.
A few hesitant Republican senators hold the future of our health care funding system in the balance. The public has indicated that this issue is the highest-ranking concern for the people. Time is quickly evaporating to repair the damage wrought upon us by the Obama administration when it pushed through the Affordable Care Act. Perhaps a short review of the situation is in order.
In a speech to the Service Employees International Union (SEIU) prior to his election in 2008, then-candidate Barack Obama indicated his wish to see a single-payer system but admitted that this nation was not ready for this move at that time.
Since the election of Woodrow Wilson in 1912, the Democratic Party has sought a national role for health care. After two world wars, the Veterans Administration system was created and expanded to provide care for soldiers unable to afford care for injuries sustained while serving our nation and for subsequent illnesses. Under Lyndon Johnson, the first steps toward a government-managed system for the public were realized in the Medicaid and Medicare systems. Again, this was intended to provide care for those unable to pay for it.
During the Clinton administration, an attempt to ensure coverage for the general public was undertaken. As that attempt was known, Hillarycare, with its many regulatory shortcomings, failed due to the opposition of the health care system lobby, particularly the insurance industry, which ran ads condemning the effort. Obama, a better politician, co-opted the insurance industry by offering its members subsidies. Further, he managed to get the support of the American Medical Association, which publishes and earns substantial income from its medical procedural coding system. Perhaps he threatened to end this monopoly.
Obamacare was conceived by Jonathan Gruber and Ezekiel Emanuel as a system likely to fail within twenty years or so. (This would be half the time that occurred in Canada.) Gruber provided the scoring method the CBO still utilizes inaccurately regarding numbers of insured. This would allow the next president (expected to be Hillary) to replace it with a single-payer system. This leap would become acceptable as the private insurance system fails due to the withdrawal of companies from unsustainable regulatory mandates. Loss of subsidies would increase the speed of withdrawal. Republicans, having reduced these during the early years of Obamacare, actually speeded up the timetable to possibly ten years or so. Already, many states have one insurance provider through the exchanges.
Forward to 2016 and the election of Trump, victorious as he offered forgotten Middle America a chance to reclaim an economic future. He understood that any replacement of Obamacare with some element of market-centered principles was preferable. Further, the elimination of taxes and regulations would free up monies and energies that could unleash the economic power of American creativity and provide new jobs and industries for those forgotten citizens. Reducing the spending resulting from Obamacare would free up funds allowing a greater tax reform plan. Republicans in the Washington bubble have missed these points as they are swallowed by the swamp.
It is possible that the 50 votes for repeal and replacement of Obamacare are less likely with McCain's illness. Now it is time for Senators Susan Collins and Rand Paul to rethink their positions. They seek different aims but will be the authors of the same result. Collins wants greater government support for her state's rural hospitals, while Paul seeks an end to government intrusion into health care decisions and elimination of new spending programs to subsidize insurance companies. Paul has suggested taking the provision to subsidize insurance companies (the pork) to a separate bill, which might help. Their points may be valid, but they miss the issue. The present system is unsustainable.
The medical funding system in America is sustained through the private insurance industry and its reimbursements for procedures in offices and hospitals. Medicaid funding does not cover existing costs, while Medicare provides funds as approximately a break-even point. This leaves the private system with its higher payments to providers to make up the loss for uninsured services. In socialized-medicine nations, the federal government covers all people with lower payments but maintains levels to sustain health care. But this comes with a price never mentioned. The Charlie Gard case explicitly demonstrates this cost: loss of freedom to make individual health care decisions for everyone.
The costs of the Medicare system have grown beyond any conceived when it was passed during the 1960s. Its future is unsustainable without substantially increased taxes and fees as the proportion of elderly increases. Then we are faced with another painful decision: if a single-payer system results from the failure of Obamacare, what will it be? The end result will likely be a revised Medicaid system that covers all. The source of funding will make the rules, and they will be normalized for all.
Perhaps the worst result of this will be lessened monies for providers: hospitals, medical school research facilities, clinics, and medical personnel. This will mean less innovation and research, as these require money. We have been an engine for new procedures and treatment, much like what McCain will be given. Although this change will be less noticeable, in time, our nation will suffer. Germany at the turn of the 20th century was among the greatest scientific researching and cultural countries in the West. But two world wars and government control of daily lives destroyed this tradition, leaving a socially managed society, a shell of its former self. Will we suffer the same fate?
Once, people were embarrassed by dependence upon Medicaid. In time, the payments for long-term nursing home care were accepted as normal for the middle class. The insurance for many through the exchanges has been a renamed Medicaid. Obama sought a forced expansion of Medicaid, which Justice Roberts rejected (through states' rights). Yet the government will ultimately control health care payments through such a system. The trajectory toward socialized medicine is hard to reverse once entitlements are given.
Liberals seek equity regardless of excellence. The march toward a national health care system is gaining momentum despite Trump's election. The window for a better solution is closing.