Some while ago Trump attacked the high cost of deductibles associated with Obamacare and said they are “practically useless”. What he didn’t say is that the man he has chosen to replace Obamacare from the scene, Tom Price, is all in favour of high deductible health plans, with patients paying for routine health problems from individual health savings accounts. The theory is that this stops abuse of the system. It would, in theory, lower premiums, but it isn’t possible to lower both premiums and deductibles at the same time. Trump at one point promised a more comprehensive health service, but this is impossible if everyone isn’t paying into the system, which is a feature of the ne Republican health bill.
Obamacare requires health insurance policies to cover a huge range of services, from maternity, preventive screening to birth control and drug addiction. Trump seems to think you can lower prices, have better care, more choices and no mandates and, simultaneously, lower premiums. As it is, because Obama knew he couldn’t get a general tax raise through Congress, he and the Democrats had to pay for the new range of Obamacare services (never previously enjoyed by poorer people), by reducing reimbursements from Medicare, increasing the tax on pharmaceutical and medical device manufacturers and employers with gold-plated insurance policies . They extended the Medicare payroll tax to the self-employed and investment income earned by wealthy investors, and made young, healthy people buy comprehensive insurance.
Was this huge expansion of healthcare somewhat draconian? In a sense it was, and it hasn’t worked well financially for many people, faced with ever-rising premiums. Now the (divided) Republicans have an opportunity to get rid of this enforced communitaire law and re-introduce “liberty”, deregulation and “community choice”. But they have the problem that they can’t relieve the young people and the rich investors who are helping pay for universal coverage without reducing the services offered to the sick and the poor, the sort of people in the countryside who voted for Trump. They will call the spade a fork and blame the Democrats, but the fact is there is no easy way to replace Obamacare without the sick getting sicker, and people dying .
The current bill, experts said, falls far short of the goals Trump laid out: Affordable coverage for everyone; lower deductibles and health care costs; better care; and zero cuts to Medicaid. Instead, the bill is almost certain to reduce overall coverage, result in deductibles increasing, and will phase out Obamacare’s Medicaid expansion. Call this a betrayal of what Trump promised.
The rational answer is a single payer system, similar to that in the UK, France and other countries (wonderful if adequately funded). But no, absolutely no, said the opponents – that is “socialised medicine”. Healthcare has advanced technologically so far and is so expensive in comparison with the post- war situation, that the ” free market” is simply incompetent to cope with the scale, the complexity and the number of poor, sick people in a civilised way. The Epicurean answer is single payer, and tax people accordingly to pay for it. Health is the most precious thing we have (speaking as someone who only yesterday learned that the local hospital , having cured me of cancer once before has just despatched a second bout, this time before it developed really seriously).
I think you’re absolutely right in the sense that the main problem with the American healthcare debate is Republican dishonesty. They claim its possible to expand healthcare coverage and reduce costs, while at the same time, lowering taxes and government spending. It simply can’t be done.
Now as a matter of principle, Republicans (Trump being a notable exception) do not believe it is the role of the federal government to guarantee healthcare coverage to all Americans. They think its a matter best handled at the state level, where they claim the benefits of lowering taxes and government spending outweigh the costs of not ensuring everyone has health insurance. If they were honest about their beliefs, there wouldn’t be as much of a problem. But instead, they’ve lied, promising that a Republican-run federal government will deliver a better version of Obamacare, when in reality, they are opposed to any equivalent of Obamacare because of their free market ideology.
If Republicans want to run on a platform of the federal government getting out of healthcare, they should do it. Its certainly what the Tea Party, who claimed to represent ‘the people’ wanted. While they’re at it, if Obamacare is government encroachment, why not repeal Medicare and Medicaid too?
But of course they won’t, because such a platform would be electoral suicide. Even if many Americans dislike Obama, they like much of the benefits of Obamacare: staying on your parents’ health insurance until age 26, the Medicaid expansion, the ban on coverage denial for those with pre-existing conditions- they all have majority support.
Soon, the chickens will come home to roost. Republicans will have been caught out for their unrealistic promises. They will be forced to abandon free market economics, because even if its beneficial, it certainly isn’t popular. Trump proved that- he won the Republican primary promising government interventions in industry, trade, infrastructure, education, and of course, healthcare.
Having said all that, I’m not entirely cheerful at the decline of traditional conservatism: that is, the limited government conservatism of Goldwater, Buckley and Reagan. Of course, Republican opposition to universal healthcare is vile. But that doesn’t mean that everything about Obamacare, or indeed Single Payer, is perfect. Governments and government programmes ought to be held to account. But they can’t be if the opposition is too extreme and has long-term declining electoral prospects, or if they abandon their beliefs entirely. Some progressives cheer at Trump’s seeming ambivalence towards free market principles. The problem is, Trump doesn’t have any principles, only whatever benefits him. We should treat anyone promising easy answers, Republican or Democrat, with extreme caution.