By Jack Bernard
Georgia Health News, Jan. 4, 2016
We are the most religious democracy in the world, and our Judeo-Christian ethic demands that we take care of the downtrodden. But we are also the only advanced democracy without universal health coverage. Are we confused…or just hypocrites?
My bet is that we are very confused. The publicās reaction to Obamacare (also known as the Affordable Care Act, or ACA) is a prime example of our confusion.
Most Americans are preoccupied with making a living and raising a family, and rightly so. They have no time to fully examine health care policy issues.
Surveys show that people do not like Obamacare, especially the mandatory insurance requirement, but most actually agree with numerous aspects of the health law, like waivers for people with pre-existing conditions.
I believe that many people do not understand how insurance works or realize that you cannot get one thing (waivers) without the other (mandates), due to the basic financial model by which insurance operates.
To amplify the confusion, many media outlets in the past few years have featured one-sided coverage and debate about the ACA. There has been too little discussion of the details of what works and what does not.
In earlier generations, new health-related programs such as Social Security and Medicare were also controversial when first proposed. Many of the objections to them were wildly exaggerated, though some skeptics had serious points. But these programs have worked out overall, and Americans have come to value them.
I am a Republican who disagrees with his party when it comes to health reform. I also recognize that the ACA has shortcomings, which many Democrats are now beginning to admit. And I believe that President-elect Donald Trump has a better understanding of how insurance works that many of his critics would admit.
With all that said, I just donāt believe we should shoot ourselves in both feet by attempting to repeal the ACA outright, as advocated by most leading Republicans.
What will Trumpās health care coverage strategy be when he is in the White House?
Apparently, with Trumpās pick of Rep. Tom Price (R-Ga.) to be HHS secretary, a repeal effort is ahead. Trump really appears to want to scrap the ACA. Meanwhile, Price and House Speaker Paul Ryan (R-Wis.) are pushing for what I see as the elimination of traditional Medicare and Medicaid.
I have grave concerns that the GOP has no acceptable alternative to the ACA, nothing that would assure coverage for the tens of millions of Americans who would end up uninsured if Obamacare goes away. The health exchanges alone currently cover 12.4 million citizens. And, what about the millions more covered via Medicaid expansion?
Privatization of Medicare, a goal of Ryan as well as Price, is not viable for economically stressed seniors, and use of vouchers will reduce coverage rather than broadening it. For-profit insurers have a 20 percent overhead/marketing expense versus 3 percent for Medicare. Yes, budgetary caps will be placed on expenditures (to the detriment of seniors). But the justification for privatization is purely ideological, not fiscal.
Block grants for Medicaid would just dump the fiscal problem on the states. Rather than blow up their budgets, states would then cut benefits and recipients, affecting care for the working poor and others.
In the long term, the GOP must change course or face the wrath of voters who will eventually be denied health care. It must advocate for expansion of a program that ordinary people in both parties know works: Medicare. That is the only realistic way to repeal the ACA and get broad political support at the same time.
It should be noted that although taxes would increase under such a plan, insurance premiums would be eliminated. More on how to finance this proposal via corporate and individual taxes can be found at the website of Physicians for a National Health Program: www.pnhp.org.
In the meantime, until there is fundamental legislation to move us in a more effective direction, the ACA is law. All Americans should get behind it. Hopefully, this next Congress will just modify the most problematic areas and give the overall health law a chance to succeed, rather than move to repeal it.
Jack Bernard, the first director of health planning for Georgia, has been a senior executive with several national health care firms. Heās a former chairman of the Jasper County Commission and Republican Party.