By F. Douglas Stephenson, LCSW
The Gainesville (Fla.) Sun, March 10, 2017
President Donald Trump and the Republican Congress seek to protect profits by replacing Obamacare. They propose to dismantle core aspects of Obamacare, including its subsidies to help people buy coverage, its expansion of Medicaid, its taxes and its mandates for people to have insurance.
Huge benefits would result for corporations and the very rich. The richest 1 percent would qualify for an average of $33,000 in tax cuts this year alone, according to former U.S. Labor Secretary Robert Reich, and a whopping $197,000 of tax cuts would be given to the top 0.1 percent.
“The 400 highest-income taxpayers (with incomes averaging more than $300 million each) will each receive an average annual tax cut of about $7 million.” Reich wrote. “It would also increase the taxes of families earning between $10,000 and $75,000 — including just about all of Trump’s working class voters.”
When Republicans dismantle Obamacare, Reich estimates that 32 million people will lose their health insurance, tens of thousands of Americans will die because they don’t get the medical care they need, Medicare will fall into worse shape and the rich will become far richer.
A major national figure in academic family medicine, Dr. John Geyman of the University of Washington, Seattle, anticipates that the proposed GOP plan will make an imploding Affordable Care Act system even worse, with a possible huge backlash from the public and even the private insurance industry when it doesn’t get all that it wants.
House Speaker Paul Ryan, R-Wisc., has called for a continuation of consumer-directed health care (with patients having “more skin in the game”), health savings accounts, high-risk pools, selling insurance across state lines, association health plans among businesses, and further privatization of Medicare and Medicaid. Health and Human Services Secretary Tom Price, as leader of the House Budget Committee in 2015, proposed the complete repeal of the ACA, as well as privatization of Medicare, sharp cuts in Medicaid funding and defunding of Planned Parenthood.
Geyman’s problem with GOP replacements is simple: They won’t work!
“Each of these directions has been used for years, and have all failed to assure Americans with better access to affordable health care,” he wrote. “They have been discredited by long experience.”
Geyman notes that the ACA was modeled closely on a health plan created by the conservative Heritage Foundation and enacted in Massachusetts Health Plan by Republican Gov. Mitt Romney in 2006. Three years later, a study comparing safety net and non-safety net hospitals found that the former played a disproportionately large role in caring for disadvantaged patients and were hurting financially.
As Geyman wrote, there are many reasons for the ACA’s failure. It relies on a multi-payer financing system with around 1,300 private insurers, which are mostly dedicated to profits instead of coverage of patients’ health needs. They continue to discriminate against the sick, profiteer and inflate their overhead to the point where the industry is unsustainable without taxpayer support.
Geyman argues that contrary to experience, evidence and GOP ideology, privatization is less competitive, less efficient and more expensive for patients than the public sector. That has already demonstrated by private Medicare and Medicaid plans, which are more volatile, offer less choice and less accountable than their public counterparts. They game the system and demand ongoing overpayments, all of which amounts to corporate welfare at taxpayer expense.
There are already wide variations in states’ definitions of coverage and eligibility, which Geyman suggests are likely to increase further as more restrictive federal Medicaid block grants to states become widespread. This will hit safety net resources will hard, seriously impacting the most vulnerable among us.
The GOP’s replacement plan will cost patients, families and taxpayers more, and we will all get less — tax cuts for the rich, and benefit cuts for the poor and middle class. Yet Republicans are blinded by ideology and seemingly unaware of the failed policies already proven by the last 25-plus years’ experience, including those of the ACA.
Of the Organisation for Economic Co-operation and Development nations, the United States ranks near the bottom in health-care justice. And yet the new Congress is moving forward with legislative action that not only increases costs and reduces benefits for the 99 percent, but further diminishes justice within our health-care system when the 1 percent become far richer.
The solution is a not-for-profit, one-tier public system of universal Medicare coverage, based on medical need, not ability to pay. Please strongly support “The Expanded and Improved Medicare for All Act”, H.R. 676, a bill now filed in Congress that resolves these problems.
F. Douglas Stephenson is a former instructor of social work in the University of Florida Department of Psychiatry and a current member of Physicians for a National Health Plan.