At the risk of being taken out and stoned by the partisans among us, I thought I’d write about health care.
A quick history
Until the 19th century, health care was a “catch as catch can” proposition. You might have access to a doctor. You might not. The Christian Church — generally the Roman Catholic Church — created hospitals and cared for even the indigent poor. But the care was uneven, spotty, and as much superstition as science — possibly more. Leeches were considered health care.
In the 1800’s, doctors were not necessarily well paid. It was a calling. No rich family wanted their son to grow up to be a doctor. There was no money in it. But he fear of death, pain, and disability combined with the advent of modern science has elevated doctors and hospitals to nearly godlike status. The cost of medical care rose. Doctors became respected. Becoming a doctor meant years of study and a huge debt. Also, malpractice suits increased, and doctor needed to pay larger and larger insurance premiums to prevent financial ruin if they made a mistake — or were simply perceived to have made a mistake. Fees rose. Health insurance was provided to defray that cost — for a price that not everyone could afford.
In some countries, like Great Britain, Sweden, and Japan, the state provided health care free of charge. (Of course, someone was paying in the form of taxes, but it was free to those who used it.) In other countries, like The United States, a capitalist model prevailed.
What we know about socialized care
We know that people under a socialized, state-run plan say they like their health care. But there are oddities that make me wonder about that. Rich Canadians with a serious condition come to the United States for care. England has a two-tier system, one for most people and another for rich people who pay out-of-pocket for their care. I know of a couple in England who had to fly their newborn child to the United States for a procedure to save their baby — one that is routinely done in the United States.
Fortunately, they could afford it.
And we’ve all heard about the long waits.
But most people under the system like it.
What we know about the Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), derisively labeled “Obamacare” by its detractors, was passed without Republican support on March 23, 2010. (During President Obama’s first two years, the Democrats controlled both houses of Congress.) When critics said it would ration health care or create “death panels”, Nancy Pelosi famously said, “We have to pass it to know what’s in it.” We know that President Obama told the American people that health care premiums would go down by as much as $2,500 a year. And he said that if you liked your health care plan you could keep it. You could keep your doctor, too. The Congressional Budget Office (CBO) estimate was favorable. They said the ACA would add to the deficit, but we would save money in the long term because more people would have health care and illnesses would be caught earlier at less expense.
But then, things the CBO hadn’t predicted happened. Health care costs didn’t go down. They went up. You couldn’t necessarily keep your doctor. You certainly couldn’t keep your health care plan. More and more providers pulled out of the ACA. Some states (like California) say they are doing well. Others, like Ohio, may soon have counties that have no health care at all.
In the midst of the furor this caused, Jonathan Gruber, a White House health care consultant, put videos on YouTube explaining that they knew all along these adverse results would occur, but they couldn’t tell the American people that or the ACA would never have been passed. Those videos have now been removed from YouTube, and you won’t hear his name mentioned on National Public Radio (NPR) when discussing health care, but his revelations were embarrassing to the Democratic party. I suspect future history books will not mention him or his YouTube videos.
Polls showed the American people did not like the ACA. The Democratic position appears to be that there’s nothing wrong with the ACA than throwing more money at it can’t cure.
What we know about “TrumpCare”
The attempts by the Republican congress to “repeal and replace” the ACA are derisively called “TrumpCare” by its detractors. As soon as they took both houses of congress from the Democrats, Republicans passed repeal bills regularly for President Obama’s veto. He didn’t disappoint them. But we all knew he would do so. The Republican votes to repeal the ACA were an attempt to demonstrate to the American people what they would do when they obtained the presidency.
What we didn’t know until President Trump took office was the Republicans didn’t mean it. “Just kidding!” they said. As soon as they had a president willing to repeal the ACA and replace it, they stopped passing the bill they had been passing for years. They cobbled together another bill which bore no resemblance to the previous one. They immediately had trouble assembling enough votes in the House or the Senate to pass it. Conservatives cried “bait and switch!” Moderate Republicans now seemed reluctant to repeal the ACA. Polls showed a sudden change in the American people. They now liked the ACA and didn’t want it repealed.
At least some Republicans are honorable. Although she had never voted for the ACA, Susan Collins of Maine never voted to repeal it. She can’t be expected to repeal it now. The “Freedom Caucus” in the house and a handful of conservative Senators remained true to their principals and attempted to repeal and replace the ACA.
But a large number of Republicans have had their hypocrisy revealed. They only voted to repeal the ACA when they knew it was a symbolic vote. Now that it could be a reality, we see it was just a ploy. They fooled us. It was a political trick. In some ways, they are as deceptive and dishonest as President Obama when he told us our premiums would go down by $2,500.
But they still want to run for office, and I’m sure they’ll have good reasons for their actions when they campaign for your vote.
The Future of Health Care
As Yoda said when Luke Skywalker asked him if his friends, captured by Darth Vader, would survive, “Hard to see. Always moving the future is.”
Will the United States get socialized health care, or will we repeal the ACA and try to return to free-market solutions? Only one thing is certain: once we have state run health care, it will never go away. Our society will become dependent on it as we are now dependent on Social Security, Welfare, Food Stamps, Medicare, Medicaid, Financial Aid for college, and tax deductions for home mortgages. Anyone who threatens the entitlement won’t have a prayer of being elected.
And I suspect that our health care will more likely resemble what we see in the Veteran’s Administration than what we have now, and only the very wealthy will be able to afford the best health care. Those wealthy will be CEOs, athletes, famous actors, —
— and — of course — politicians.