Put aside your political partisan loyalty for a moment and ask yourself this question:  is access to quality, affordable healthcare a human right or is such access subject to the choices you can make with the money you have in the “healthcare marketplace”?

Trumpcare? Ryancare? Nocare?

Lots of stuff in the news lately about Obamacare and Trumpcare…..The Donald and the Republicans want to “make good” on their campaign promise to “repeal and replace” the Affordable Care Act.

Paul Ryan rolled out the Republican “replacement” plan….it has earned dislike from stanch conservatives and progressives alike, although for different reasons.  They are even running ads on TV trying to sell the plan to the public, especially in districts where members of their own party are not in favor of the plan.

It doesn’t help that the non-partisan congressional advisory group, the Congressional Budget Office, says that the originally presented replacement plan* would lead to 14 million fewer Americans with health insurance by 2018 and 24 million fewer by 2026.  It would on the other hand reduce federal deficits by $337 billion over the 2017-2026 period.

According to this analysis from Fortune Magazine:

The house plan, entitled American Health Care ACT (AHCA), essentially caps what the government will pay to aid families and poor people, and what it will spend in total, regardless of how fast medical costs increase. Consumers will pay the difference.

The plan may indeed create what the Republicans envision, a regime in which Americans buy coverage mainly for catastrophic illnesses, and pay for everything routine from their own pockets. And that’s not a bad thing…. [It could lead to ending] a system where big subsidies that discourage shopping and encourage over-consumption, are the driver, not the solution…..That is one way to achieve “affordability.”

“The competing view holds that only rich, income-based credits that fully protect consumers from the relentless rise in medical expenses can prevent busting family budgets. “The AHCA takes the opposite approach, so that old and poor people will drop their coverage,” says Matthew Fiedler, an economist at the Bookings Institution. “The Republicans are saying that the federal government doesn’t have the responsibility to make healthcare affordable.”

So will consumer choices coupled with limited coverage drive marketplace choices that bring affordability to healthcare?  Or will people simply forego healthcare if they don’t have adequate coverage….waiting until they are so sick they cannot avoid waiting?

Now, let’s put on the table the issue that the “marketplace” also includes many people with adequate coverage through Medicare, employer group plans and similar situations.  So there are plenty of consumers out there keeping demand up….so the people who lose coverage under “repeal and replace” and are forced to make these personal choices are only one component of the demand piece of the affordability puzzle.  Prior to Obamacare they were faced with similar situations of limited to no coverage and healthcare was not driven into becoming “affordable”.  I’m not sure why this Republican plan would now lead to that outcome.

Past practice has shown us that if individuals and families cannot afford health insurance, they generally follow the following steps:  They worry about getting sick.  They don’t utilize preventative care. When they get sick, they ignore or self-treat until the situation becomes too bad.  Now with worse conditions, they present at acute care or emergency facility where the costs are higher.  The overall personal result is that their quality of life is lower (stress of worry, no prevention, delay in treatment) and costs are higher (ER treatments).

Why do we allow our fellow humans and friends to go through such a process?  Why do we subject their lives to making tough marketplace choices?

To repeat our opening question: is access to quality, affordable healthcare a human right or is such access subject to the choices you can make with the money you have in the “healthcare marketplace”?

Some Kinds of Choices are OK

To me, everyone should have access to basic affordable healthcare.  They should be able to receive preventative care and be able to go to the doctor when they are sick with a reasonable out of pocket cost. There should be a set standard of basic healthcare services that are available to everyone.  This doesn’t mean that our system cannot build in some choices such as these:

  • Coverage for some optional services beyond the basic ones.
  • Choices of doctors and hospital networks.
  • Choice whether to receive services or not.
  • Choice to pursue healthcare services or providers who are not covered.

In addition, I do believe that the use of reasonable cost sharing methods can and do limit over utilization of healthcare services.

However, I do not think that the choices should be between going to the doctor when you are ill or paying your rent/mortgage or other bills.

Healthcare is a Human Right!

I have written before that I see healthcare as a basic human right.  As I look around at other citizens of my country, I believe that by the very nature of their humanity they should have certain needs met:  food, shelter, water, education, access to making a living by working…..and maintaining their physical health.  That’s not to say that there is not some choices in the quality of what is provided….someone can decide whether to spend their money to increase the quality of their food, shelter, education, health care…..but we should ensure that everyone has access to at least a basic level of services and care.  If you don’t believe that, then we perceive our fellow humanity differently.

Recently Bernie Sanders has been visiting areas of the country that voted for Trump to listen to them and their needs.  Below is a video from a visit to West Virginia where they discuss coal and jobs and the economy.  It’s an interesting exchange but ends with the question about is healthcare a right…listen to what this coal miner says:

So as we move through this “repeal and replace” sideshow, here is what I encourage you to consider as you listen to the rhetoric:

How does the plan and benefit that is being discussed view people?  Does is consider in regards to our fellow citizens and human beings that  access to quality, affordable healthcare a human right or is such access subject to the choices you can make with the money you have in the “healthcare marketplace”?

Then after you answer that question for yourself, ignore the rhetoric and decide for yourself if the proposal is in our best interest.  Does it match our personal values? Does it match the highest values that we hold for our country?

Then let your voice be heard!

Mark Gilbert

*As this article was published, there was news that the Republicans were considering changes to their proposal.


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