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How Republicans Tried to Kill Obamacare and Give Us the Cheap Ryan Substitute.

April 11th, 2017 · No Comments · ALEC, Budgets, Economics, General, Health Care, jobs, Labor, Lobbying, obstruction, Politics, Populism, Social Security

I just heard from the Republican House member from my district, Peter Roskam, on health care.

He thanked me for expressing my support for Obamacare, which was nice as he obviously has a different point of view, having voted for repeal 51 times and now having tried to pawn off on us this new, more health-insurance-industry oriented plan. His reasoning is that Obamacare is a “massive, new government operation aimed at making sweeping changes to the entire U.S. health system.”

Well, let’s take a look at that statement. Maybe he’s right. European systems, much better than ours and cost half what we pay for health care. European systems never have denied anyone health care…rich or poor…or in their cases…not even tourists. Obamcare is far less intrusive and far less comprehensive. It involves only those who do not have employer-based health care, which is about 85% of the population. People already had Medicaid and children had SCHIPS, vets have VA and seniors have Medicare. We are talking about a limited segment of the population, not a massive undertaking. Workers with insurance plans were covered.The poor, veterans and those over 65 were covered. So all this big hullabloo was over about 20 to 30 million Americans, out of 312 million. Certainly not “massive” by any standard of government programs that Republican Congressman Roskam is used to approving.

Look, the goals of Obamacare were pretty specific. One goal was to keep people with property and income from becoming bankrupt from medical bills. About half a million people a year were going bankrupt specifically because of huge medical bills. The other goal was to get medical care for  the “in-betweens” those who did not have employer-shared insurance policies, so that they would not show up at emergency rooms on their deathbeds. That is not unreasonable.

One benefit from this was to take an intelligent look at health care costs by panels of health care professionals and decide the best forms of care and the best ways to cut costs to get to those best outcomes in the most cost efficient manner. Our system, even Republicans would say, is unwieldy, inefficient and expensive. Statistically, no one in Canada or anywhere in Europe says that they would exchange their system for ours. We hear a lot about Canada’s problems, especially from spokesmen and women allied with the health insurance business but surveys repeatedly say that no Canadian wants to give up their healthcare system for one like ours. Although Canada has a better system than the U.S., there are at least a dozen, perhaps even two dozen better than theirs. We are way behind, folks.

Republican Congressman Roskam, further says: “I was optimistic that with these areas of common ground, Congress and President Obama could work toward real progress.” The fact is that after a year of debate and over half a billion dollars in campaign money and political action committees directed towards the Republicans and over 400 amendments by them, meant to delay inaction or defeat the purpose, the Republicans had no alternative of their own.

Every single Republican but one in the House voted against Obamacare. Every single Republican in the Senate voted against it. There was no active debate on the part of the Republicans. Many Democrats who had tried unsuccessfully to engage them were frustrated and no longer tried to hide the problem. One Democratic Congressman finally said it on the floor of the House. “The Republicans are a wholly owned subsidiary of the health care industry.”

When you address Congressman Roskam’s comment about Obamacare being a “massive government program”  here are the facts. Obamacare insures about 20 million Americans who are between the ages of 27 and 65, and does so with subsidies to both businesses and individuals. Medicare insures 40 million people smoothly and easily. Those people pay for Medicare from a monthly deduction in their payroll check for about 45 years, from the time they start working, from about age 20 until age 65.

At age 65, they pay a monthly charge deducted from their Social Security, then very often pay a big deductible and a monthly premium for a Medigap plan, then pay a prescription drug plan that reduces the cost of prescription drugs. Finally, there are co-pays in many medi-gap plans and in most prescription drug insurance plans. So the American worker pays for his retirement reduced health care plan all his working life and into his retirement years. And yet, given the American system of health care, in surveys senior citizens always point to Medicare as something they would never voluntarily change.

President Reagan said in 1960 that Medicare would turn the country Socialist. If that is true, then the citizens of 250 of the 335 legislative districts in this country voted for the wrong person. Because those are ultra-Conservative, Republican House members. But even though Medicare is popular and not Socialist, it works well because it has low overhead.

You see, if you have a $500 bill from Medicare, that bill is processed for about 3%. So the bill is $515,( the simple arithmetic is: $500 x 3% = $15 + $500 = $515.)  But if you have a bill from a private insurance company, the bill from that company (with the CEO making an average of $14 million a year) will cost $650,($500 x 30% = $150 + $500 = $650) Just simple arithmetic. So the private insurance companies charge much more in order to make a profit to pay that CEO a ton of money to do the same thing that the Medicare government employees do. The health insurance companies are designed to make profit. Hence the name “for-profit.” Medicare is non-profit, or government run. For the same reason Europe has half the cost of American health care. And, by the way, in the rankings of countries according to best health care systems, by the World Health Organization, we rank 37th, between Costa Rica and Slovenia.

Republicans like Representative Roskam accuse Medicare of being overly costly.  But, as you saw from the very rough arithmetic our health care, even if we had no subsidies a public system reduces general health care costs by one-third. And why shouldn’t we subsidize health care for the masses? We have the money. Income inequality is rampant in this country. We can definitely tax billionaires.

Once a man has a billion dollars or a family even, they can’t really spend any more. Let’s say that a man makes a billion dollars once, by age 20. Good for him. So now he has, without any interest at all, $12.5 million to spend on his family…every year for 80 years. There is no good reason that anyone needs to spend more than that on his family per year, even a large family. Over that amount, the individual should pay 75%.

When Senator Claire McCaskill asked a town hall group at the outset of Obamacare, if they wanted it, the majority said..NO. No keep government hands off their health care! But when she asked how many had Medicare, a lot of hands went up. Then she asked, “How many of you want to give up Medicare? Please let me see the hands of those who want to give up Medicare.” Not one single hand went up.

You see? We Americans, as a group, are statistically no longer civil and kind and compassionate and caring and neighborly and, most important…no longer intelligent. We have listened for so many decades to the paid propagandists of the Right Wing billionaires that we no longer know what is true and what is not. It hardly seems necessary to mention that every news segment on Fox News has some blonde in the middle flashing long legs at the camera while the news anchors relate some details that often have no relation at all to what is actually happening. Every Obama story has a bad ending. Every McConnell story has a reason why Obama is distrustful and the Republicans have only good plans for jobs, health care, better retirement, higher wages, if we will all just wait a little longer. It is right there on the horizon waiting for that evil Obama to leave office. The unions are always thugs and the Occupy Wall Street people are described as “terrorists.”

But, back to health care, the new name  for the plan to replace Obamacare is quite forgettable so I just call it  “Health Care If You’re Dumb Enough to Accept It.”

The main Republican argument, as I see it is that Obamacare has become too expensive. at least according to the House member in my district. And it can’t be fixed; it must be replaced. But that is wrong. Until 2014 and really not until 2016, the costs of health insurance were kept lower because part of Obamacare was to make sure that rates stayed low by promising the insurance companies that for a while the U.S. would back their honest mistakes in estimating rates. If they were too low, the government would bail them out. If they were too high, they would credit the government for the difference. This was all because the Obamacare plan covered everyone with a minimum package. Insurance companies had to take all comers now, sick or not, and because they all had to offer what anyone would consider at least minimal services in an insurance package, insurance rates became more difficult to predict.

But in 2014, Senator Rubio of Florida and the Republicans threatened to shut down the government rather than help these insurance companies with these subsidies, some of which were very substantial. They made no attempt to hide the fact that they did it to force companies to raise rates, hoping to make Obamacare un-affordable. Senator Rubio said that he was proud of ending this “bailout’ which he knew would seriously damage health care for hundreds of thousands, perhaps millions. A number of new, smaller companies were forced out of business. Rates on average, which had been going down, suddenly went up. To understand why, under the Rubio Amendment, a corporation that had a loss of $1,000,000 and was promised full reimbursement, and had been getting it, was suddenly only covered for $130,000.

Before Obamacare, in the Bush/Cheney years, insurance premiums for small businesses and individuals were going up at 10 to 15% per year. Congressman Roskam and the Republicans can go back and massage those numbers all they want but that is what employers, like myself, had to pay for health insurance before the ACA. Under ACA, or Obamacare, the rate of increase had fallen to only 4% and in some areas had gone down to zero. Then in 2016, because of the problems of the Rubio amendment, premium rates by 7.5% and in 2017 with many of the smaller companies driven out of the marketplace and some states like Alabama with only one health insurance provider, some rates would go as high as 22%.

This is what happens when you have half the government, the Republican Party, no longer in the service of the people, but in the service of giant corporations. And you have Senators like Rubio willing to gamble on the fact that his constituents are too stupid not to re-elect him. He counts on the image of a man with some distant relationship to Cuban exiles, many of which were merchants beholden to the dictator Batista. Others were true refugees, for some reason in real mortal danger from the Communist Castro regime. We don’t really know which Rubio’s family was.

Even with all the Republican obstruction and interference, Obamacare provides an outstanding option for 8 out of 10 of those in need of private health care. The government estimates that of this population, one that needs, reliable, inclusive health insurance, most can buy it for $100 per month or under.

If Rubio had not interfered and created the default on payments promised by Obamacare, health insurance companies, particularly young, developing companies, would have been encouraged and rates would have continued to go down.

The Republicans’ point about fixing premium pricing and pre-existing conditions is laughable. Obamcare simply said that you will take people who have pre-existing conditions. So what is the problem there? The problem, again, is that the Republicans work for the health insurance industry. And Obamacare does not worry too much about what the very profitable–for the most part–health care industry worries about, namely, greater profits.  Although they actually know better.  (They may be evil and greedy but they are not stupid.)

Here is the problem. The Republican so called “Ryan plan” only offers those with pre-conditions this alternative—a high risk pool that they can “join.” (Not joining, given that they are high risk, generally means that they can alternatively choose death or bankruptcy or both.)  Higher risk means higher rates. Remember, Republicans look at it from the insurer’s point of view. Every policy must make a profit. The higher the risk the higher the cost. This is about what makes insurance companies profitable.

Which brings us to the philosophy of health care and health insurance. If you believe in the for-profit system, as the Republicans do…and there is not one shadow of a doubt that they have left about whether they are…then you worry first about the sustainability of insurance companies and their ability to make unlimited profits.  This is why you become impatient with subsidies and customers who may have a high risk factor. In a for-profit system, there would be no health insurance without profitable health insurance companies. You see, the way the capitalist system works is that corporations are people whose job is to make themselves endlessly richer…themselves being the stockholders like, say, Trump or almost anyone in his Cabinet.

In a public system or a not-for-profit system, like the Swiss system, the goal is to maximize health care for the people at the lowest possible cost. So, in Switzerland, there are companies that administer health care very efficiently but they are regulated companies. And we here in the United States, in our somewhat limited vision, we know that regulations, like clean water and unspoiled meat and limits on campaign spending…are impossible. They are not compatible with profits. In the antiquated and outdated thinking of Europe, however, where Italians have 4 more weeks of annual vacation and 4 more years of life than we do, regulations help them, they say. Surprisingly, Italians are very happy people. As are the Dutch, German, Norwegian and French people…who all have universal, inexpensive, much more highly ranked health care than we do.

So despite what the Republicans and Paul Ryan and Peter Roskam says about what did or did not happen or will happen with Obamacare, the fact remains, you cannot have cost-conscious health care and for-profit health care. Look up the study done over 50 years ago by Nobel Prize Winner, Dr.Kenneth Arrow on the comparisons between the two possible ways of handling health care…for profit systems or public systems. You will quickly come to realize why the Catholic Church or Lutheran or Methodist Churches or Adventist systems or the Shriners became sponsors of hospitals. Because health care is antithetical to the idea of profits.

The bottom line is this. We take care of people because they are our fellow human beings in need not customers. We care for them not because we want to make money from their distress but because it is natural for human beings to have compassion and sympathy and a desire to end pain. The more we profit from the illness of others, the less caring it makes us feel.

As a society we must decide whether our principal goal is to set up and make profitable companies that sell helath insurance to our fellow citizens. Or whether we migh set up organizations that handle billing and administration for a healthcare  system that puts care for all our citizens first. Not America first but Americans first. So let our fellow Republicans, now in total control, make the decision whether to serve the people, or serve industry. They cannot do both. I vote that we put people first and profits somewhere out of the picture altogether.

 

 

 

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