Why I Am For The Republican Health Care Bill

By

Leonard Zwelling

Not surprisingly, The New York Times’ editorial page hates the bill that might emerge from the Republican-controlled US Senate. If it at all reflects the House version of the bill it will displace the health insurance of over 20 million Americans, many of whom are poor and receive some insurance under the ACA. The new law would provide a huge tax break to wealthy Americans who do not need any further government largesse. This brief summary simplifies the effects of the Republican idea of health care reform, but it’s close enough.

How then could a rampant proponent of a single payer system like me, backer of a system approaching Medicare for all, possibly support the bills emanating from the GOP-led chambers of both houses of Congress?

Because, it is my belief that the only way to the single payer solution is through a path of pain paved by bills like the one that may be passed by the Republicans and signed by President Trump, although this seems less likely by the day.

The lack of understanding by the Congress of how most health care (not just insurance) is paid for is laughable. Far more health care is consumed by those over 65 than by those under that age. Thus, a great deal of health care is paid for by the federal government already in the form of Medicare. The poor, disabled, young and nursing home-bound are covered by Medicaid and that’s a big bill, too. This is another government program using both federal and state funds. Add the cost of health care at the VA, the military and the Indians and about half of all health care is paid for by governments already with Medicaid being the biggest item on most state budgets.

Wait. I’m not done.

The premiums for health insurance paid for by those employed by insurance-providing business entities are tax-exempt. That is about a $200 billion loss to the federal government. If you buy that same insurance on the open market, something that significant numbers of Americans do, they pay with post-tax dollars. How is that fair? Of the approximately $3 trillion spent on health care in America, over $10,000 per capita and twice that spent anywhere else in the world, much of it is already coming from your tax dollars. Yet there are still those who will march in protest to “keep the government out of their Medicare.”

To many of us, this is all nonsense. The only logical solution is that access to affordable, quality (yes, let’s really measure what our doctors and other providers do) health care (not insurance—care!) be provided for all Americans via some form of government payment system while leaving the provision of the care in the hands of private entities like hospitals and doctors’ practices. In other words, Medicare for all.

The political barriers to a single payer plan are as yet too high to overcome. Only once all Americans demand it, will it come to pass. Doctors are coming around and so are many of the public, but not enough. There are still a great many who believe that the government cannot do anything right. Really? The government has done a pretty good job of keeping the country safe since 9/11. The NIH is still a reliable funder of important research. We are better for having the EPA than not having it and the CDC does a reasonable job of controlling our susceptibility to mass epidemics. And let’s not forget the military. The armed forces are still the most respected group in the country and they ought to be. Add the police and fire fighters and other first responders—government employees all—and you get my point.

It is sad that it may require the increased pain of the GOP health plan to get us where we need to be with regard to actual health care delivery. But I am confident we will get there. At the current rate, under the ACA, I suspect my kids will live to see Medicare for all. Under the proposals coming from the GOP Congress, I might. Once emergency rooms back up to six hour waits to set a broken arm and academic and other safety net providers go broke under the GOP bill, then the public will demand the single payer system that people like Bernie Sanders have requested for decades.

I’d rather the latter and thus I wish the GOP would get on with it and pass a bill that is sure to explode the health insurance market and lessen the number of Americans with access to affordable health care. Then we can finally get around to doing the right thing.

“You can always count on Americans to do the right thing after they’ve tried everything else.” So said Winston Churchill.

Let’s get on with trying everything else like this GOP nonsense so that we can get where we really need to be and where the rest of the civilized world already is.

Leonard Zwelling