As I write this, Donald Trump is soon to be our next President.  He along with the Republicans in Congress have stated that their first order of business with the new administration is to repeal the Affordable Care Act.   According to reports, they are already laying down steps to do this. This is no surprise, the House of Representatives has been passing bills to repeal the law many times over the past few years…they just never got passed the Senate.  Now they can.

It is almost comical how overturning the law has become the extreme right’s symbol of the repudiation of the Obama Presidency.  Almost.

Anyone who has not linked their sense of identity to a whole package of ideas that is presented as the right’s dogma (“This is what the Republicans say is correct and since I am Republican this is what I must believe.”) has to stop and wonder why there is such a rush to repeal.  Shouldn’t we stop and take our time and “do this right”?  Not if you’ve been chomping at the bit to overturn the law in some sort of “I’ll show you” power play.  The illogical rush to repeal Obamacare is childish bullying showmanship at its political worst. 

Trump says he will “repeal and replace”….at his press conference yesterday, he said the replacement would happen almost simultaneously. We’ll see.  I hope that calmer heads prevail and the promised actions to “replace” are timed in a way not to disadvantage people.  The devil, as always, is in the details.

The video below gives a good summary of what would happen with a repealing of the law without action to replace some provisions.

Meanwhile, states such as my home of Colorado get ready for shifts in their healthcare marketplace as described in this Denver Post article.

Again, why rush a change that will have negative consequences?

Is the law perfect? No.  Could it be better? Yes.

Early on, I was both a supporter of the law and a critic of it.  Here are links to a few of the posts I have written on this topic going back to 2010:

Healthcare Deals and Our Greatest Ideals

Your Opinion of the Healthcare Bill — Coming from Love or Fear?

The Health Care Debate – Free Market Choices or Basic Human Right?

Healthcare, Dignity and Pizza

My bottom line is that everyone should have access to affordable health care as a basic human right.  I was in the group that favored a public option (and closer to my real belief that we could make a true American national healthcare system work best).  It was very telling, in my opinion, that a public option was not included in the Affordable Care Act due to concerns by private insurers  (who, I suspect,  knew that a public option would force them into more competition than they were willing to face).

However, to be fair, those who dislike the Affordable Care Act generally point to a couple of major and somewhat valid criticisms — most notably the “mandate” and our experiencing rising costs of health insurance since the law which often costs employers more. There are other reasonable concerns as well.  But there are also major benefits of the act.  Here is a well balanced description of the pros and cons of the law.

Let’s look briefly at the mandate.  The mandate says one must have health insurance or pay a tax as a part of their Federal return.  Here’s a good description of it. There are reasonable exceptions for not having to pay the tax if you don’t have insurance.

However, for many, the real issue with the mandate are concerns over  having another instance of the government telling you what you must do….including telling you what you must purchase.  There are, of course, plenty of examples where the government already requires us to do things (such as pay taxes, obey laws) and buy things (auto insurance if you have a car). People who place importance on limiting the power of government certainly want to have the freedom to live their lives without purchasing health care if they don’t want it.  I get this point of view, I do, ..but I don’t agree with it in this case.

The problem, of course, is when these uninsured people do need health care and find themselves unable to pay their bill. As many have pointed out — all of us pay the costs for those who use health care services and cannot pay.  A person in an emergency situation costs more than someone using preventative services.  A person without insurance is more likely to wait until their situation is worse (generally going to the ER) before seeking health care….then the cost of care is considerably more (and the person’s experience is considerably worse).  The provider then “writes off the bill” when they are unable to collect (although the individual who cannot pay can get their credit screwed up just like on any unpaid bill).  The healthcare provider then charges it off as something called “uncompensated care”.  It’s a loss on their balance sheet but they still seek to make a profit.  How do providers make up for this loss?  In some cases, they can get reimbursement from the government (such as hospitals who have “disproportionate” amounts of this uncompensated care).  In most cases, they raise the cost of care for everyone else.

A  possible interesting side effect of Obamacare’s lowering the number of uninsured is that uncompensated care is at a 26 year low for hospitals.  Again, that means the hospitals are not having to raise their rates as much for the people who can pay.  Reports are already coming out that repealing Obamacare will raise uncompensated care by over a trillion dollars.

So those who want to immediately repeal the Affordable Care Act….I have to ask you this —which is better:  (1) having more people with health insurance which they are now generally required to carry which means that our society’s cost of uncompensated care is lower….or (2) having more people without insurance whose health care costs get passed on at a greater rate to all of us?

I have worked around healthcare and insurance much of my life and one of the conclusions that I have come to is that paying for health care is like pushing on a partially blown up balloon.  You can lower something somewhere by squeezing one area of the system it but it generally always increases something else somewhere else.  Our healthcare “system” (which is not really much of a true system but rather a hodge podge of parts pushing against each other and frequently causing unintended consequences) is a real teacher of the truth that everything is connected.

So now, if we are not careful, the rush to repeal the Affordable Care Act by political ideologues bent on making their point is going to create undesired consequences for the citizens they claim to represent.  An outright and immediate repeal of the law would lead to millions no longer having insurance and all of us paying more indirectly for their uncompensated care.  It will lead many to foregoing needed health care services out of concerns over the cost that they cannot pay.

There must be a better and more caring, more reasonable approach to this.

At a minimum, I would hope that Congress and the new President take some thought and allow some time to ensure that a well planned and reasonable replacement is put in place such that the impacts on families and working people throughout the country is minimized. I have no concerns that what they do will work out better for corporations.  That seems to be the norm with our government lately. However, it would be great if any changes makes it better for real people.

At the back of all of this is a difference of opinions on one basic belief — is healthcare a human right?  

Some say “no”.  They believe that a person should have the freewill to choose insurance or not and that the marketplace should be free to offer health care services at whatever price the service can bear.  Hidden in this point of view is the reality that many people end up not having the ability to pay for their health care or not getting services at all.  The frequent result is that the poor get sicker and poorer.  Those who chain their political positions solely on the illusion of a “free marketplace” simply shrug and say “oh, well, that’s just how the ‘marketplace’ works.”

On the other hand, I say “yes’.  If you are a human being living in the United States (or the world for that matter), you have value.  You are important.  And related to that is the importance of you being able to maintain your physical and mental health through the access to and receipt of high quality, timely and appropriate healthcare services.  I get it that people want to limit government and put faith in an free economic marketplace.  However, there are plenty of other things that we can choose to be concerned about limiting the scope of government intervention.  And, there are plenty of other areas where we can allow the so-called “free marketplace” to play out the laws of supply and demand and the connected prices.

An America that treats all of its citizens with dignity and respect and offers everyone regardless of economic status access to high quality and affordable health care transcends any political ideology.

Mark Gilbert


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