Republican members of Congress are catching hell from constituents after their votes to repeal the Affordable Care Act and replace it with ... well, something different. The bill that eked through the House made a lot of changes in federal health care regulations. One of the most significant of the changes eliminates the guarantee that a pre-existing condition will not prevent you from getting health insurance. Instead of Obamacare's blanket prohibition against discrimination against people for pre-existing conditions, the new GOP rules would make insurance available to people with epilepsy, cancer, diabetes, heart conditions, etc., but only after a waiting period and only at much higher costs, if at all. An estimated 20 million-plus people would die in the next decade because of these changes.
"Obamacare" was passed on a party-line vote seven years ago in an attempt to standardize health insurance nationwide by setting standards that health insurers were required to follow -- free birth control and other services; pre-existing conditions could not be excluded from coverage, all policies had to cover maternity care; health insurers could make only so much profit; etc. Meeting all the requirements of the ACA strained health insurers, leading many to forgo writing policies in some states or to pull out of some places after finding their premiums did not cover costs.
As new-President Trump admitted, "Who knew health care could be so complicated?" Well, the Democrats who tried to pass health care mandates in 1993 and finally succeeded in 2010 knew. Health insurance is an arcane, complicated business. Throwing government regulation into the equation made it more so.
My prediction is that the health care plan that comes out of the Republican-led Senate will not satisfy consumers. The Affordable Care Act tried to make the system work by mandating coverage, penalizing with tax penalties those who refused to sign on and subsidizing those too poor to afford premiums. Doing all that requires a lot of regulations and a lot of monitoring. Mandating coverage creates a large enough pool, most of whom are healthy, that the costs are evenly and fairly distributed.
Instead of increasing the complexity of health insurance, why not simplify it? The way to do that is though a federally run health insurance program (like Medicare). Every employee and every employer would pay into the system, but every employee and employer would no longer have to pay private health care premiums. A single-payer system would enjoy great economies of scale and could operate more efficiently than the hundreds of scattered insurance companies and agents across the country.
Everyone would get the same coverage and pay a standard amount with the wealthiest and/or most unhealthy paying more. This system works well in England, France, Canada and most western nations. It works because if the entire population is in the "pool," the healthy can help pay for the care of others without exploding premiums.
The reason to pass a single-payer health-care plan is not because there is a "right" to health care (the Constitution is silent on this issue). It should pass because anything else is either too complicated or too controlled by a greedy health-care and insurance industry that sees sick patients as sales to be maximized.
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