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Words from Winterbilt

The election, health care and working together

Shannon Bohrer

(8/2017) The election we had last fall seems to still be with us. The Republicans say the election is over and they won. The Democrats say they are not obstructionist, but they won’t work with the Republicans unless they can have input. And with very few exceptions, both sides seem divided on how to govern the country. History tells us that our politics is often divided – and sometimes our politics represent our differences. But, sometimes, similarities do exists.

A good case could be made that there are times when the parties are divided because they want to be, not because of their differences. Our approach to health care could be an example of this. We know that our health care system is broken and it was broken before the Affordable Health Care Act (ACHA) was passed. We also know that the ACHA was modeled after proposals from the Heritage Foundation, a very conservative organization. The health care system adopted in Massachusetts under Governor Romney, was from the same conservative model. So if the Democrats used the conservative model (from the Heritage Foundation) to create the Affordable Health Care Act, why was it opposed?

It was opposed, at least in part, because the opposition party agreed to oppose everything that President Obama did. On the night that President Obama was sworn into office a group of fifteen opposition leaders met at a restaurant in Washington DC and agree to obstruct everything the presidency did with the intent of making him a one term president. After President Obama was reelected, the same opposition group’s objective was to make his presidency a failure.

I would expect that some readers would disagree with what I have written, but these are not alternative facts. With very little research you can find information on the group that met on the night that President Obama was sworn in and you can also find the Heritage Foundation and their original health care proposal. Of course you can also find numerous statements saying how different the ACHA was from the Heritage Foundation’s proposal, which should not be unexpected.

In 1989, that’s right; 1989, the Heritage Foundation put forth a proposal for universal health care. The proposal outlined problems within the medical industry such as cost. Does that sound familiar?

The Heritage Foundation recommendations included:

A. State-based exchanges that would exist where residents may compare and purchase private insurance policies. The objective of these exchanges is to drive down premium costs by increasing competition, and provide policies with similar levels of coverage for ease of comparison.

B. A guarantee issue, meaning consumers cannot be denied coverage due to pre-existing health conditions.

C. Subsidies for lower-income households. The proposal included subsidies for lower income individuals, to ensure affordability.

D. Mandatory participation in a heath care program.

The "Affordable Health Care Law" includes:

A. State based exchanges, where individuals can shop and purchase health insurance. The objective of these exchanges is to drive down premium costs by increasing competition in the free markets.

B. Individuals with pre-existing conditions cannot be denied coverage.

C. The government provides subsidies for lower income individuals, with subsidy percentage dependent upon the level of income.

D. Required participation, meaning everyone must have health insurance.

While some have consistently denied that it resembles the Heritage Plan – to do so is to create alternative facts. The basic elements in both are almost identical.

If you belong to a party that voted to repeal the ACHA over 60 times, because it was such a disaster, you have to make it look like a disaster. Remember, you only had two choices when the ACHA was passed. The first choice is that you liked it - even though the opposition party passed it, but then you’re not different. To be different, you have to be against it, which is where we are. So while you can be against it to be different, what happens when the public finds out that it was not a disaster?

While the ACHA was a step in the right direction, it does have problems that should be addressed. Our Health care system is a mess, primarily because it’s not about heath care; it’s about the business of delivering health care. Currently our health care is one sixth of our economy, or 17.6 percent of GDP. The average heath care cost per-individual in the United States is $8, 233 per person.

The Organization of Economic Cooperation and Development, (OECD) composed of 34 members, estimates that the U.S. consumer pays two and one half times more than the other members in their group. In a recent report on health care quality, by the same organization, the United States ranks 11th. Ahead of us are the UK, Switzerland, Sweden, Australia, Germany, Netherlands, New Zealand, Norway, France and Canada. As a group (the ten countries ahead of us) they pay about half – of what we pay!

To help to reduce the costs -one option that has been talked about is a single payer system. Having so many insurance companies has never lowered the cost, but single pay with Medicare and Medicaid is efficient and does work.

A large argument against single payer is that the only organization that can deliver single payer is the government. And a large problem with that is when the government delivers health care, it does not make individuals responsible and it becomes an entitlement. Then again, if you pay for it, is it still an entitlement? As to not being responsible, we also have a long history of private companies not being responsible, so maybe that argument is a little weak. For example, does anyone really believe that the banking industry would be responsible without regulations?

If we go back in time to 1965, when Medicare was enacted, we can view the issues with some historical clarity. Medicare was not proposed because of some grandiose idea that the government should insure everyone, it was proposed because private insurance companies – cancelled policies when persons reached the grand old age of 65. Why did they do that? Simply put when people get older they get sicker, they see more doctors and have more procedures. The insurance companies knew this and they made a business decision not to stop covering the elderly. Simply put it was not profitable.

A popular argument against the government running our health care is that our Constitution does not guarantee health care. Neither does the Constitution guarantee public education, roads and bridges, police and fire services. The government does not guarantee a lot of services it provides, including Medicare. However, the government – provides services to us that private industry cannot, or in some cases does not do well. So - maybe health care falls into that group.

I believed that eventually we will have single payer health care, but not anytime soon. In order for the government to provide single payer health care, the government would have to raise taxes. Raising taxes to provide services – is just not right. Everyone knows we should have free services like roads, education, and fire and police protection – without paying for them. After all, this is America!

Eventually, when health care cost is 25 percent, or more of our GDP, we might actually look at a single payer system. It’s not because we can afford it; it will be because we cannot afford the current system.

Read other articles by Shannon Bohrer