Dream of Obamacare repeal turns to nightmare

Americans are clear about what they want from any health care reform.

They want simpler policies, fewer surprise costs, lower deductibles, cheaper prescription drugs and lower out-of-pocket expenses for their health care. They also like protections for pre-existing conditions, they support Planned Parenthood and they want more people to have coverage.

The newly released Republican plan in Congress is also clear.

It takes away health care from millions of people, makes insurance even more complicated, increases deductibles, increases out-of-pocket expenses — particularly for older and low-income Americans — does nothing about prescription drug costs, but does give massive tax benefits to wealthy people. Also, it defunds Planned Parenthood.

As Emily Brostek of Consumers for Affordable Health Care said Tuesday, “This plan seems to do almost everything that most Americans oppose: fewer people will be covered, costs will be higher and basic protections will be lost.”

It doesn’t solve anyone’s problems — not even those of a president and a GOP caucus who promised to repeal Obamacare.

The plan has landed with a dull thump, even without an impact analysis by the Congressional Budget Office.

House Majority Leader Kevin McCarthy, House Speaker Paul Ryan, and Rep. Greg Walden introduce the American Health Care Act on Capitol Hill on Tuesday. Eric Thayer | Reuters

House Majority Leader Kevin McCarthy, House Speaker Paul Ryan, and Rep. Greg Walden introduce the American Health Care Act on Capitol Hill on Tuesday. Eric Thayer | Reuters

Democrats have panned it for hurting millions of families by taking away their insurance and driving up costs, and conservative Republicans say it costs too much, is just Obamacare Lite or just won’t work.

Even Gov. Paul LePage says he opposes the bill — and he doesn’t understand health care or the Affordable Care Act enough to understand why he doesn’t like it. He’s all over the map. But doggone it, he knows when he doesn’t like something, regardless of the facts. And he doesn’t like this.

Oh, and he doesn’t like Obamacare, or President Obama for that matter, except for the health care market exchanges, which work because of subsidies paid for by taxpayers and the individual mandate that requires everyone to have health insurance or pay a fine.

So he’s heading to Washington (again) to lobby against it, and maybe hunt for a job.

As President Trump has belatedly discovered, health care policy is complex.

But fundamentally, every question about health care comes down to one easy-to-understand choice.

You either believe that everyone, regardless of income or situation in life, should be able to receive medical care when they are sick or injured, or you don’t, and you put qualifiers on who is worthy of health care.

The reason our health care system is such a mess is because we want to avoid this basic question, and we hide the debate in bogus ideas such as personal responsibility and market-based reforms.

The entire system is constructed to create a myth that health care is delivered through a more or less free market. Conservatives believe that greater faith and reliance on this free market will deliver better and less expensive results.

But it doesn’t, and it won’t. Health care isn’t a commodity like any other. People don’t and can’t always make rational choices, and they have no real individual power to bargain.

And we’ve already accepted that the government has an important role to play in guaranteeing health care for millions of people.

Even before the Affordable Care Act, huge numbers of people received their health care through the government: Seniors who receive Medicare, veterans and members of the military, poor children, some people with disabilities, low-income pregnant women, state workers, county workers, city and town workers, and people who work at public schools and colleges.

Taxpayers also subsidize the cost of insurance for people who receive their health care through work.

In one way or another, the government is helping to provide health insurance coverage for those people either directly or through subsidies hidden in the tax code.

The Affordable Care Act took this a little further by mandating that young adults can stay on their parents’ health insurance until they’re 26 (a reform pioneered in Maine), by providing subsidies for low-income workers to buy coverage on the health care exchanges and by expanding Medicaid.

And the ACA, while not perfect, has worked. It reduced the number of people without insurance to record lows while also reducing the overall cost of the health care system and reducing the federal deficit.

Twenty million more people have insurance today because of the reforms of the Affordable Care Act.

Republicans now control the presidency and both chambers of Congress. The easier veneer of opposing Obamacare has been stripped away by the difficulties of crafting legislation that can actually pass.

Democrats now have it easy. They must stay united and oppose this disaster of a health care rollback.

Republicans, on the other hand, are going to have to decide — very publicly — whether they think everyone should have access to health care or if only some people should. And they’re going to have to say who doesn’t deserve it.

With Trump’s various promises to not kick people to the curb and cracks already showing in the Senate and House, seven years of dreams about repealing Obamacare are already turning into a political nightmare.

David Farmer

About David Farmer

David Farmer is a political and media consultant in Portland, where he lives with his wife and two children. He was senior adviser to Democrat Mike Michaud’s campaign for governor and a longtime journalist. You can reach him at dfarmer14@hotmail.com.