Thursday, July 27, 2017

A Conversation About Health Care

In response to the GOP effort to repeal the Affordable Care Act (ACA), I was sucked into a Facebook conversation (I know, I know better). Spoiler alert: I was against repeal. For the possible amusement of my future self, I reproduce the conversation here (well at least my part, which is only slightly edited). The "points" in favor of repeal are greatly condensed (hey, it's my blog; if you want your say, that's what the comments are for). The "counterpoints" are my own wordy answers. The whole thing was kicked off by a third person's comment that taking health insurance away from millions of people is not the Christian thing to do.

Point: As a method to "help" people, Obamacare further entrenches health care within the swamp that is "political ideology."

Counterpoint: As a method to "help" people, I propose making health care affordable and accessible to all, whether that involves charity (which is individuals acting for the good of others) or government (which is us, acting collectively for the general good). In contrast, supporting removing health care from millions is elevating political ideology above the teachings of Jesus.

Point: Did Jesus lobby the governments to force people to change things? No. There is no biblical example of government coerced redistribution of wealth. Jesus expects us to give freely, joyously and voluntarily.

Counterpoint: I don't believe Jesus would care whether universal health care was achieved via government or via insurance companies. I do believe he would favor the outcome either way. Ironically, the ACA was the conservative approach of doing it through private insurance companies. Now that conservatives are declaring that route a failure, expect that when liberals regain control of government, they'll do it the way most other countries do it, and how the US itself does it for seniors (Medicare) and for the poor (Medicaid). The logic of and demand for Medicare-for-all will eventually become irresistible. When that happens, conservatives will have themselves to blame.

Point: Obamacare is a disaster.

The biggest lie that President Trump and other Republican leaders have been repeating about the Affordable Care Act for years is that it is collapsing, imploding or exploding. The truth is that the law is actually working reasonably well, and even the part that has shown the most weakness — the health insurance marketplaces — has been stabilizing.

Point: Obamacare choices could go from one to zero in some areas.

Counterpoint: Republican sabotage of the ACA is hurting the exchanges, but even without that, ACA does face challenges in some areas, particularly rural areas with small populations, older and more in need of health care. There are ways to address this, but Republicans prefer not to. The individual mandate was always a weak and inefficient means to ensure that healthy young people sign up for health insurance while they are still young and healthy. Replacing the mandate penalties with a simple, straightforward tax would help. Second, insurance companies have always been cautious about committing to an uncertain system. Modifying the risk adjustments, reinsurance, and risk corridors would entice more insurers to offer plans in ACA. There are other improvements, but, as I already said, the GOP prefers to take insurance away from people, not find ways to increase coverage.

Point: The VA (Veterans Health Administration) is a disaster.

Counterpoint: The VA is another topic. I'll just say that, like public schools in Texas, it's under attack by Republicans, who are squeezing it of funds and then complaining about poor service, all in the goal of privatizing it. Meanwhile, the majority of veterans value the service they receive.

Point: Making people pay taxes to subsidize health insurance for others is slavery.

Counterpoint: I am familiar with the libertarian position that taxation is theft. The vast majority of people believe that taxation is the price we pay for a civilized society. Taxation is a necessary part of the social contract in which citizens surrender some of their freedoms in exchange for protection of more important rights. Even conservatives argue that everyone should pay taxes lest they come to believe that the benefits of government are free.

Point: Instead of Obamacare, we ought to be encouraging competition between insurers.

Counterpoint: The ACA was designed with conservative input (Heritage Foundation, RomneyCare) to rely on competition among insurance companies. By and large, it's working, although improvements are needed (see my comments above). Repealing ACA will return us to the days when competition among insurance companies alone was a proven failure in providing universal health care.

Point: We should reform the legal system to a system where the "lawsuit lottery" is not the norm.

Counterpoint: Texas has already implemented so-called lawsuit reform. The result is that victims of malpractice cannot get justice because of the caps on compensation. And even with lawsuit reform, Texas still has one of the lowest levels of health insurance coverage in the nation. Lawsuit reform is not the solution.

Point: There is a disconnect between payer and consumer. This removes any incentive by the insured to keep costs down.

Counterpoint: One cannot simultaneously complain about high deductibles and about a disconnect between payer and consumer. Choose one. Comparing picking gas stations with choosing which emergency room operation procedures are used to treat your heart attack is silly. The health care industry is unlike any other consumer market.

Point: One of the impediments to all this is envious and hateful people who resent it when companies make money.

Counterpoint: Envy of people making money is not an impediment. As I said, the ACA was designed under principles that rely on market-based insurance companies. It's the conservatives who are now complaining about this system. Mark my word, if ACA is repealed it will eventually be replaced by a single-payer system. Even conservatives reluctantly admit this.

P.S. Most of the above arguments are moot. Universal health insurance is not a Republican goal. For some Republicans, the loss of health insurance by millions is just collateral damage from getting the real goal, a big tax break for the rich. For others, taking away health insurance from those who can't afford it is a feature, not a bug.

P.P.S. In the heat of conversation, I presumed to speak for Jesus. Mea culpa, mea culpa, mea maxima culpa.

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