It’s hard to pin down U.S. citizens about what they think of our healthcare system. Letters to the Editor, congressional townhall discussions, polling data all suggest keen interest. 55% of poll responders “worry a great deal” about healthcare insurance and go on to list “affordability” as the number one issue. A recent poll revealed that 70% of U.S. adults supported Medicare for All proposals as long as there was an option to maintain private insurance. There are also 28 million people (8.5%, first increase since 2010) who remain uninsured.
My December 11, 2019 column “Wonderful but Impractical” made a case for universal care being, most of all, kind and suggested that it would be possible to deliver government- controlled insurance at a more reasonable cost. I made a case, but did not prove beyond a doubt that we could do so. Universal care works affordably in 32 countries, but those countries are not the U.S.A. It will take a leap of faith to make healthcare universal (the kind part) and affordable (the practical part). Some suggest diving into the deep end with immediate Medicare-for-All insurance, while others argue that we have already put our toe in with Obamacare and need to nurture and expand that program to include a public option and updated subsidies––perhaps for small business owners––all the while keeping the parts of the Affordable Care Act upon which citizens have grown to depend.
These suggestions manifest in the plans of Democratic candidates across the ballot. I’m not being biased here and only writing about liberal ideas and plans. There simply are no Republican plans to evaluate.
The Republican talking-point closest to a plan is the long-standing, association health plans where groups are formed to negotiate cost and coverage directly with insurance companies. The idea that small businesses and even individuals could band together and lobby en masse, for better rates is logical but comes out a loser to having 330 million people in one large association dubbed “United States Population.”
Associations are tough to defend as many are tied up in court over fraud charges. Offerings have historically been less than candid about what they do and do not cover. Insureds have been surprised to find their policy does not cover doctor visits, chemotherapy, emergency care, or perhaps prescription drugs. Plus, insolvency resulting in insureds being left holding a stack of medical bills has been a common occurrence. The pitch to sell the idea promotes customers buying across state lines. Problems arise because selling in multiple states necessitates being exempt from state regulations, which ends up allowing insurance companies to offer junk policies. The ACA addressed some of those concerns by setting minimum standards for coverage.
The 10-year campaign against the ACA has been steady, but failed. Starting with Speaker John Boehner, continuing with Speaker Paul Ryan, including continual support from Senate Majority Leader, Mitch McConnell, “Repeal and replace” has echoed loudly through Congressional Chambers. It has been all bravado and chest-thumping to date. There is still a vocal call for “repeal” but no evidence of any method to “replace.” Donald Trump bragged in June, 2019 that a “phenomenal healthcare plan” would be revealed in “a couple months.“ On another occasion it was, “just around the corner.” Seven plus months later––nada. Seema Verma, the administrator of Centers for Medicare and Medicaid Services, claims the administration is “working on things.” Those “things” remain unspecific, undefined, unpresented, and unreviewable. White House spokesperson Kellyanne Conway said in August, 2019 that an “announcement is on the horizon.” We have been given no concrete reason to believe that the administration is indeed “actively engaged in conversations” about healthcare as Conway also claims. No fruit of any “conversations,” any work on “things,” or that any announcement, either “on the horizon” or “around the corner,” has ripened into reality.
Republicans are relying on Texas v. United States, a suit against the ACA where the Fifth Circuit Court of Appeals struck down the individual mandate requiring everyone to buy a plan, but did not rule on the overall constitutionality of the act. It may be heard by the Supreme Court before the 2020 elections. If Republicans get a favorable ruling from SCOTUS, that will kick 30 million citizens off insurance plans with their only option being trying to buy a policy from Aetna, Hartford, et. alia. At that point policies will not have to be sold to anyone with preexisting conditions and will, once again, cap company liability.
Also “on the horizon” is a chance for a bipartisan prescription drug act to lower costs and prevent price spikes. This seems the best bet for any Republican action related to healthcare. There has been a one percent drop in drug prices in the last two years, mostly in generics. But, without this bill being enacted, there is no guarantee of continued price controls.
Logic runs something like this: Most Americans think healthcare insurance needs revision. Therefore, legislators and the administration should act. Democrats won a majority in the House of Representatives in 2018 largely due to focusing on solid plans for revision of healthcare insurance. They continue to ask about and listen to constituents’ concerns. Republicans have been vague, presenting zero healthcare insurance plans for consideration. Therefore, anyone who considers healthcare a vital election issue has only Democratic choices in the next election.