Wednesday, October 30, 2013

Alternatives to Obamacare

I had an epiphany yesterday.  Republicans in the House have voted to repeal the ACA 46 times and not once have they offered an alternative.   The reason that they have not offered a reasonable alternative to Obamacare is because Obamacare was their idea.  Yep.  Back in 1974, the Nixon administration proposed an insurance program where all employers would provide insurance for all of their workers or face a fine.  The poor would be added to an expanded Medicare and small businesses and low income folk would receive a government subsidy to help cover their insurance costs.   It failed because Democrats wanted a public system rather than one based on private insurers.  In 1989 the Heritage Foundation proposed a law with an individual mandate requiring everyone to purchase insurance and that feature began showing up in Republican proposals for healthcare reform up until Newt Gingrich made it a centerpiece of his agenda when he was Speaker.  All of this on the federal level.  Then, of course, Romney established a very similar plan in Massachusetts on the state level.  Obamacare is a Republican program.  A Democratic program would have centered on a public option with a single payer.  The ACA is not socialized medicine, it is a program based on the private sector. 

There are other options to the ACA.  I prefer a single payer, public program.  I think that is the only way to address the myriads of problems in our healthcare delivery system.  There was no way the Republicans would have voted for truly socialized healthcare and there were enough Dems who would have sided with them that it was an idea that was dead in the water regardless of whether or not it might have been the best idea.  It never even made it to the table for discussion.

I have heard two other options mentioned by some.

Leave the system alone.  That is fine if you are someone who has good insurance from your employer without a large employee contribution or never experience any illnesses or accidents that cause injuries.  It leaves out the folk who have no insurance or are under-insured.  It causes many people to forgo treatment until it is too late and sends others to the most expensive healthcare option of all, the emergency room.  It leaves those out who have pre-existing conditions which preclude them from purchasing insurance (and there is no way to stop insurance companies from excluding pre-existing conditions without an individual mandate).  And regardless of what folk say, healthcare does not work like any other "free market" industry so in this option there is no way to slow the runaway price increases we've all experienced.  Leaving it alone is not an option that I can see as making any sense at all.

I've recently seen multiple folk advocating another option which I find sickening (excuse the pun).  They are arguing that we do away with insurance completely.  Healthcare would become like any other commodity on the market with individuals bargaining with physicians and hospitals when needed, health care going only to those who can afford it, and the "free" market running its course.  In their minds, those who are healthy would not have to subsidize those who are not and those who are not in this scenario are always caricatured as irresponsible folk whose poor choices are causing their problems.  While there are many who do not need regular doctor visits or medications and think they can go without insurance, one accident or unexpected illness changes everything in a heartbeat.  Those folk argue that a free market would bring down costs, but never imagine the ridiculousness of sitting in the emergency room with a broken bone sticking through their flesh while arguing with the doctor about the costs or leaving to go 55 miles to another hospital that treats heart attacks more inexpensively.  I presume they would argue that anyone arriving at the hospital must pay in advance or not receive treatment.  Without that stricture, who would pay for those who receive treatment and never pay?  Most of all, this kind of idea completely excludes any sense of community and the greater good for the entire community.  I can't help but think of politicians in New York and Colorado who argued against government disaster funds until their communities were struck by Sandy and terrible floods and they saw the light that we really are all in this together.  The only folk for whom this option works are the very, very, very few who never get sick or injured or the extremely wealthy.

Are there other options that I've missed?  Realistic ones that preserve a sense of community?  I agree the ACA is not the best option.  I would even agree that it does not represent any sense of a compromise.  In spite of the fact that it was passed by the Dems,  it is a completely Republican idea that Democrats supported, expecting that Republicans would own the baby they birthed.  They did not.   And they offered no reasonable alternatives... because their proposal was already on the table.

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