Economic Issues

Is the ACA Worth Saving?

The initial reaction from establishment Democrats will likely be "Of course it is, look at the alternative!" ...and then point to the Trump administration, as if that were the only other possibility. Trumpcare is generally lauded as "a big mess" by the mainstream media, and Trump is portrayed as incapable of comprehending his own healthcare bill, let alone the one he's set to "erase". Then there's the secrecy that surrounded it, the inevitable MSM spin, the public outrage, the death threats ...it went on and on. It was very similar to the initial reactions and aversions to Obamacare, when it came to pass. In fact, it was almost eerily similar.

What exactly is the American Health Care Act, or "Trumpcare"? In order to best answer this, it's necessary to first answer the question "What is Obamacare?".

The Patient Protection and Affordable Care Act, or ACA, at the time of its conception and passing in 2010, was the first major overhaul of the US healthcare system since Medicare and Medicaid were passed in 1965. It was hailed as a way for millions of previously un-insured people to find affordable health insurance, even if they had pre-existing conditions. By most accounts, that happened. But what really happened, was that insurance was doled out, not based on need, but on ability to pay. Yes, many more were insured than before, but networks were sparse, their benefits were often weak, tiered, and not even worth the added household expense. Meanwhile, big insurance boomed.

Republican opposition was of course monumentally loud and showy in their attempts to kill the ACA, but ultimately their arguments against it completely missed the point. They claimed it would "kill jobs" due to an unfair cost to businesses, although job creation in the healthcare industry rose by 9% in the months immediately after the ACA went into effect. This was at least partially due to the sudden need for wasteful administrative positions, but the point is that the opposition should have predicted that, and probably did.

These disingenuous attacks were not really designed to kill Obamacare, they were simply there to build partisan mistrust and division. Republicans criticized the ACA for eight years, then suddenly had to base their "better" healthcare bill off of it almost completely, while pretending to struggle with creating it (the struggle was in marketing it). If they had really wanted to attack the ACA, they could have, with genuine arguments, but then they would be undermining a system that they are potentially just as invested in.

But what was the real problem with the ACA?

The real problem with Obamacare, is that it was written by an insurance company executive, and if you examine it closely, it completely revolves around insurance company profits.

And that, is Obamacare. That's the system that establishment Democrats are fighting so hard to defend. People are screaming that the AHCA is a big mess, and they're right. The reason why, is because it's directly modeled on that big mess that you see. Follow the money. Look where the money is going, and where it's mostly coming from. That is the reason why Republicans refuse to harp on the one, true major flaw in Obamacare: because the AHCA does the exact same thing, just to an even greater degree.

So why fight for it at all?

Trumpcare is the threat used to garner support for Obamacare right now, but healthcare inflation was the threat that was used to garner support for it initally. This inflation is global, but is deeply worsened by privatization, by inherent flaws within a health system driven by profit. If this privatized inflation is the root problem, then how is pandering to private industry completely, supposed to fix it? We already pay higher prices for prescription drugs and healthcare in the US than anywhere else in the first world, for very little return. How is going in the opposite direction to most of the developed world supposed to protect us from these high healthcare prices?

So Obamacare is not all it's cracked up to be but how is Trumpcare any different? They are basically the exact same thing, with a few relatively minor changes. Why would the insurance companies which wrote both healthcare bills, and benefit the most from both healthcare bills, change the basic way that the ACA is set up? It's already perfect for them. Everyone pays them, and they only have to pay out to one agency, while they reap endless profit. Meanwhile, everyday people have to pay insurance premiums and deductibles to private insurance companies, taxes to the government, AND copayments to medical facilities, all to keep the corporate money machine cranking. The people who need the benefits most, are actually the ones funding a parasitic system which is killing them.

The differences between the two systems are devastating, to be sure, but arguably they pale in comparison to the problems caused by unfettered greed in both cases. If it weren't for corporate dominance of our healthcare in the US, we wouldn't be arguing about who we should let die. That's not to say we wouldn't be arguing, but that's not the argument we'd be having.

You can look at it this way: Our current healthcare system is a machine. It has all sorts of gears, levers, and switches built in. What Trumpcare has basically done, is tweak a few of these dials, and flipped a few switches. But why were those controls built in, in the first place?

There is no denying that Trumpcare is bad, but let's look at the specifics.

  •  Cuts to Medicare
  •  Cuts to Medicaid
  •  Tax breaks for big business
  •  22 million to lose insurance?
  •  Cuts to women's healthcare (Planned Parenthood)
  •  Premium age differences (Older people can be charged up to 5x as much as young people for the same coverage. State-issued waivers can exempt this limit. With Obamacare the limit was 3x.)

The idea of cutting funding for the poorest among us, and the oldest, not to mention women, who already aren't getting enough, is bad enough. Add to that the inevitable increase in the already staggering rate of income inequality when the fortune 500 have to pay even less taxes, and it's not looking good for middle class America, let alone the very poor. But what about 22 million losing their insurance? According to Paul Ryan, the loss that's predicted to occur over the next 10 years can be attributed to people who "opt out" of the insurance, presumably the same people who were "forced in" by the ACA's individual mandate in the first place?

So... they will have a choice, whether to have health insurance or not? Is this going to help them afford healthcare? Is this going to keep people alive, healthy, and contributing to society? Is that even the point? My point is not actually to prove that the ACA and the AHCA are identical, but to show that the parasite feeding off of the system is the same in both cases, and to varying degreee, is the root cause of each system's failures. It's not so much a question of Obamacare vs. Trumpcare, both are corporatecare. Trumpcare just takes the worst things about Obamacare, and makes them even worse.

Even if the rates go down with the AHCA, but more and more is expected from the patient to pay out of pocket, with dwindling benefits, is that an improvement? Sounds like all that's happening is premiums are getting swapped for deductibles. It's all going to the same place. And even if the rates would go up beyond what those 22 million are currently paying, and suddenly they became unable to afford the insurance, is that a deliberate choice to "not buy insurance"? Is having a pre-existing condition a deliberate choice?

There would be something deliberate going on, but neither of those are it. The deliberate act, is called out-pricing, and it's designed to keep things out of the hands of the very poor, who need them the most. Neocons' laughably pathetic, and totally predictable response will be "They have a choice whether or not to be poor". Just watch.

So it seems that all, or most, of the threatened changes to our healthcare system are simply adjustments to mechanisms that were already in place. But again, why are those mechanisms there? Isn't there a much simpler means of ensuring that ALL citizens of the US are insured with decent healthcare, without private agencies getting involved, simply to profit off of it at our expense?

Yes: Universal healthcare!

Those extra mechanisms are completely unnecessary, and are only there to ensure that private insurance companies remain at the center of the operation, and that their profits are paramount.

Invariably, when the subject of single payer is breached, there will be someone who says "Sounds great, but who will pay for it when 47% of Americans don't even pay federal income tax?" My response is in three parts:

1) That's only Federal income tax, not state taxes, property taxes, SS taxes, sales taxes, or any other kinds of taxes.

2) One of the main reasons why 47% do not pay Federal income taxes, is because their yearly income is so low that it's deemed statistically insignificant for the purposes of Federal taxation. And yet people still don't see the real problem. Raise the minimum wage, enact a federal jobs guarantee, stop practices which increase income inequality, end legislation that mandates it, and you will soon fix that problem. Nothing more to bitch about.

3) Thanks to the wonders of Modern Monetary Theory, taxes don't fund spending on the federal level anyway, only at the state level. The money creators in Congress could literally write this reality into existance. Yes, poverty is a choice, but the people feeling the effects of that poverty are not the ones choosing it for themselves. It's being chosen for them.

Due in large part to a push to delegitimize the government in favor of corporate autonomy, there is a growing mistrust of the government in the US. It is ironic, in that the mistrust is deserved, but the reactions are often misplaced, and that is by design. As a result, there will be many who say that they simply don't trust the government enough to entrust their most vulnerable necessities to them.

But do they trust corporations more, when they creatively skirt our laws with such precision, and charge us so much more for LESS care than the rest of the world? Can they look at both charts representing our current system & single payer, and still say that they trust our current system more, with the obvious extent to which it can be (and has been) corrupted through loopholes? If you think Trumpcare is bad, it can get worse. There can be less funding for social services. There can be more tax breaks for big business. There could be more skyrocketing profits for insurance companies at our expense. Premiums, deductibles, benefits, subsidies, copayments... they can all be tweaked at will. There is always that threat, all the time.

Unfortunately, some of the strongest voices opposing single payer are likely going to be Democrats. The Democrat establishment line on the matter is you take the money and do what you're told, and the money says "Kill single payer." If all of these pundits who accuse people of being ignorant of what's in the AHCA would stop doing that long enough to actually read the AHCA themselves, they would see that there is at least one good thing about it, over the ACA. Trumpcare would allow consumers in the US prescription drug market to purchase their drugs from other countries like Canada, allowing them to save potentially huge amounts of money. This is big. This is something many people, including Bernie Sanders, have been pulling for, for a long time. But unfortunately, that's not popular among the Democratic elite.

And of course, you're bound to get the person saying "Socialism never works, just look at Russia." Are we still having this argument? Sadly, yes, we are. Even after years of explaining this over and over again, about how Communism is not Socialism, and how Socialism is defined as being "for the people", and how Democratic Socialism differs from National Socialism (Fascism), in that it is government which is both "by the people" and "for the people", there are still people who want to pull out this tired argument. A much more honest comparison would be to take a good look at France, for instance.

In spite of vast discrepancies in the quality of care between American and European healthcare systems, somehow Europe accomplishes more at a fraction of the cost. According to WHO, the U.S. spends nearly 17 percent of our gross domestic product on health care, while receiving relatively poor quality care. That translates out to about $6,100 per person. Now compare that to an average 8.6 percent in European countries. France somehow manages to accomplish stellar healthcare for much less, coming in at a cost of about $3,500 per person, even though it has the top-rated health care system in the world. And yes, they have 100% universal healthcare.

So is a purely universal healthcare system the ONLY other alternative? Nope. There are many countries with mixed public/private options, in the same way that the US has been a mixed system since 1965, when Medicare and Medicaid were passed. It's a spectrum really, from almost purely private to purely public. What's probably most important though, is that the the US is the ONLY mostly private, mostly profit-based healthcare system in the world.

In light of all this, is the ACA worth saving, or not?

It may not even be an issue. The fact that Sean Spicer states that we'll either get the AHCA or Single Payer, is interesting. Yes, Spicer is likely blowing smoke, ironically threatening us with what we all want, but the push for universal healthcare has charged ahead full steam, not only in spite of the GOP threats, but with greater velocity because of them. Is this tenuous time, in light of all the impending havoc before Trumpcare possibly goes into effect, an opportunity in disguise for single payer to take hold? The Expanded and Improved Medicare for All Act, H.R. 676, based on an AJPH-published Physicians’ Proposal, would establish a single-payer health insurance system in America.

...Don't just stay tuned, stay alert, and stay active!

Write to the Democratic (and Republican) House members who aren't supporting H.R. 676, and tell them why it is so important to you!

To read about H.R. 676 go here.

For the latest info on H.R. 676, go here.

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