As the Trumpcare train gathers steam, quite a few Republicans look like they might just jump out of the way. I am represented by Rep. Budd who, in a favorably gerrymandered district and in a state using voter suppression tactics, won his seat by 56%. Sen.Tillis won by 48.8% and Sen. Burr by 51.1%. One would think it might be in their best interest to tread carefully on an issue that affects the pocketbooks, sickness and health of their constituents.
Candidate Trump, who only garnered 45% of the popular vote, eked out an electoral college win in part by promising a replacement for Obamacare that would 1) provide improved coverage 2) for everyone 3) at a lower price. For that reason, self-preservation suggests the wisdom of a vote to reject the dog’s breakfast the House has served up since it would do none of the above.
In unveiling it, the oblivious Sean Spicer praised the Trumpcare Plan graphically by stacking the huge Obamacare bill next to the skinny Republican replacement and boasted that it will mean less government. But the bill will also mean less coverage or no coverage for many people. Millions of people.
The Republican Party is acting as if the purpose of healthcare reform is to reduce the size of government, but that is not what Trump promised. He promised better care for less money with no one left out. Now his HHS Secretary Tom Price says no, the real goal is not healthcare affordable by all, but access for all. This a semantic joke. I have access to an apartment at Trump Tower. I just don’t have access to the $5 million needed to buy it. And access to healthcare without the do-re-mi means you are without care.
Among the Republican lies told about Obamacare was that it would use death panels to euthanize the elderly. But Trumpcare really could be a death sentence for the most vulnerable patients who will lose their coverage.
Notice who has come out in favor of the House plan — the Chamber of Commerce, an anti-government, pro-business lobbying group, and wealthy taxpayers who will receive tax breaks worth billions. Who has come out against the plan? The American Medical Association, the American Hospital and Nursing Associations, the AARP, and governors who are about to be left holding the Medicaid bag.
They see that the plan diddles with tax credits, health savings accounts and other funding gimmicks to shift government costs to taxpayers but fails to provide healthcare for those who need it, which was the goal of Obamacare. Republicans gung-ho to repeal without replacing might find messing with some of its provisions perilous. For example, if the Obamacare ban against denying insurance to people with preexisting conditions were repealed, 52 million might find themselves uninsurable.
The Kaiser Foundation reports that 57% of Americans already get healthcare from their employers or other private plans. Another 14% are oldsters who are on Medicare, which brings us to 71% covered. The most vulnerable are the remaining 29%, 20% of whom are poor people on Medicaid and 9 percent the uninsured who can’t afford insurance and pray they won’t need it. But sooner or later everyone needs healthcare.
Yet almost nothing in the plan addresses this most vulnerable 29%. Instead, the plan aims to cut federal spending for Medicaid and tell the states to take up the slack. This is essentially an unfunded mandate which many states may not be able to afford. Ten million people now on Medicaid could lose care. And tax credits to help defray the cost of insurance don’t help many of the uninsured since they don’t earn enough to take advantage of the credits.
Republicans argue that dumping responsibility on the states is a good idea because states know best about how to care for their own people, but Is there any evidence for that? Poor states care poorly for their people and prosperous states can afford more adequate plans. So under Trumpcare, where you live and how much you earn will dictate how you are treated and whether you will have good healthcare, poor or none. Should geography determine which Americans get sick and which stay well?
The Trump/Ryan plan shows what happens when you design healthcare not by thinking about the needs of people, but about the idee fixe of libertarian ideology. By this calculus, that healthcare plan is best that reduces government most, not cares for people best. Under such plans the cost trends may improve, but trends don’t need chemotherapy or heart bypass operations. Individuals do.
In a moment of embarrassing self-revelation Ryan used a powerpoint pie chart to show how a few greedy sick people with medical bills expect a lot of people without medical bills to help them pay for it. To him this was tantamount to socialism. To the rest of us it is the idea behind insurance — a communitarian, capitalist innovation designed to spread the cost of risk widely, thus making protection affordable to all.
Donald Trump, members of Congress and their prosperous donors may favor a cheaper, more ideologically pure healthcare plan that will shrink government, give tax breaks to the well off, and deny coverage to those who need it most, but those who actually have to face the consequences, like doctors and nurses, not to mention patients and their families, know this is not an economic experiment or game of partisan one-upmanship.
Healthcare reform is about the health of actual people. Those ensconced in elite comfort may never have had to worry about paying a doctor or affording a prescription, so don’t see what the fuss is about. As Tennyson said, the farmer may plow but only “the toad beneath the harrow knows exactly where each tooth point goes.” Only the uninsured know exactly what it is like to not to have a doctor’s care when they need it
Trump won by pandering to segments of the population that felt themselves neglected and at risk, but Trumpcare, as designed by Ayn Rand acolyte Paul Ryan, will do nothing to improve the lot of many of them and will make the lot of millions worse. Despite Trump’s promises, the plan he is now pushing will not cover everyone. It will not make their coverage better. It will not cost less, but will only shift the burden to those who can’t afford to bear it.
If Republicans, like Rep. Budd and Senators Burr and Tillis, choose to vote for Trumpcare, they must expect to kiss good-bye those newfound Trump voters who believed him when he promised they’d receive improved, affordable healthcare. This isn’t it.