16 March 2015
The Health Care Plan Republicans Always Wanted-Until They Got It
As Robert Reich noted (link below) Obamacare is almost exactly the sort of health care reform that Republicans have said they always wanted, going all the way back to President Nixon. (Yes, that Nixon and yes, the situation is really that bad.) Reich points out that it is Republicans who have always insisted on private insurers rather than a Medicare-Social Security based system.
It was Republicans who came up with the idea of an individual mandate, which Mitt Romney successfully carried through in Massachusetts. Reich concluded by noting that since Democrats had to pass the ACA without Republican support they could have held out for a single-payer, Medicare-based system that would have actually worked. Possibly. But Republicans would surely be apoplectic over any health care plan that Obama (or any other Democrat) came up with. And there’s the problem, for both the Republican party and the people of the US.
Just about everyone you ask, Democrats and Republicans alike, will tell you that universal health care should be a right.
So, if the ACA is essentially the plan Republicans would have come up with if they had to come up with a plan, how come they’ve lined up against it as though it were the anti-Christ? Follow the money: Health care in the US is a business—a very good business. Average per capita spending on health care in the US is over $8,000 per year. Republicans don’t want health care reform, many even claim it isn’t needed. They also claim that if market forces are given free reign then competition will drive costs down.
Medical care in the US is basically a cartel.
Insurance companies, not patients, are the consumers. And they’re part of the cartel. They don’t care if Big Medicine charges exorbitant prices. They can just raise their premiums. Their cut comes off the top so they always get paid.
Try calling up a hospital and getting a price for a surgical procedure. Ask about something simple, like a hernia operation. They won’t tell you because the real answer is “it depends.” (See the “possible exception to the rule” link.) Mostly, it depends on your insurance (like whether you even have insurance). If they were to be honest with you (they won’t be) they would tell you that the price is “as much as we can get.” In other words, it’s a negotiation—but not with you, because you aren’t the consumer.
The negotiation is with your insurance company. Your insurance company decides what your co-pay will be. Your insurance company decides which hospital you can use. This is based on the deal the insurance company worked out with the hospital. You have no say in the matter, even though you’re paying for it. There is no other business arrangement in the world where this would be tolerated. Would you hire an electrician to rewire your house if the price he quoted was “it depends?”
There is a critical point that most people do not seem to understand:
Insurance companies are not in the business of paying for health care. Insurance companies are in the business of collecting premiums.
Insurance companies are the consumers of medical care. The insured (you) are the consumers of insurance. All the money that goes into the pockets of insurance companies comes from you, whether you pay them directly or your employer pays a share.
And about that; any insurance provided by your employer is part of your compensation as an employee. It is not a gift provided out of the goodness of your employer’s heart. When Hobby Lobby claims that they shouldn’t have to pay for contraceptives because it runs contrary to their religious beliefs, what they’re really trying to do is foist their religious beliefs onto you, forcing you to adhere to their religious principles as a condition of your employment.
That’s the conservative version of religious freedom. You, as an employee, are free to adopt the religious beliefs of your employer. Conservatives complain about the nanny state but they’re fine with the fundamentalist feudal state.
It’s pretty simple: Republicans hate Obamacare, mostly because Obama, a black Democrat, got it passed. The Affordable Care Act is deeply flawed, precisely because it is more of a Republican plan than a Democratic one—but it’s a start—an essential start. Republicans don’t want to talk about any kind of health care reform because they know that the only one that makes sense (based on our own experiences and those of just about all the OECD countries) is a single-payer system.
Medicare, our Medicare, (the so-called “entitlement program” that we pay into all of our working lives) is way more efficient than private insurers, doing a much better job of containing costs.
Just prior to the implementation of the ACA, our “system” of health care was financially unsustainable. And Republicans couldn’t have cared less. They’re happy to ride us all into the ground and bleed us of every last dime. That’s the Republican version of health care reform.
The fact is Republicans offer nothing. Nothing. They are the party of “No.” The party of No obstructs, obfuscates, obliterates and offends. The party of No does not solve problems.
The party of No is the problem.
So, why does health care in the US cost so much? The graph below tells a big part of the story. Mid-life and end of life (EOL) care costs are far higher in the US than anywhere else. In 2011, 28% of Medicare spending was for care in the last 6 months of life. Just what are we getting for these insane expenditures? Has anyone ever gotten out of this life alive?
Do you suppose that these huge EOL expenditures buy us more time and better quality of life? It doesn’t appear so. The US ranks about 33rd in life expectancy in the world (not far behind Costa Rica and Cuba). Average life expectancy in the US is 78 years. Average per capita health care spending in Cuba is about 1/20 what it is in the US. Most Americans say they would prefer to die at home but 75% of us die in hospitals or nursing homes.
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