The Fiscal Irresponsibility of #Trumpcare

If anyone is waiting for the Republican Party to do anything to “fix” the health insurance system, they are wasting brain cells. It’s never going to happen because it, quite literally can’t happen. You see, it is possible for Republicans to deal with economic matters, in the abstract, but they will always deal with them from a “market-based” perspective. The problem is, healthcare isn’t “market-based.” And even if you could make the case that healthcare delivery has some market elements to it, the problem we have is with insurance, which is most certainly not subject to traditional market rules.

Think about it. Healthcare is one of the few things that everyone will need at some point in their lives. That means everyone. Everyone gets hurt at one time or another and everyone dies; the only questions are when and how. And both of those questions are completely unpredictable. And I mean completely unpredictable. If I am buying a car to replace my current car, I can look at the mileage and current condition of the car and make at least a bit of a guess as to when it will have to be replaced. Then, I can make a plan and arrange for vehicle financing whenever I want. The same is true when I am in the market for a house; there are plenty of people who can make educated guesses with regard to how long my house will last and whether or not the house I plan to buy is a good value.

With virtually any consumer product, I can plan a purchase, I can arrange for financing if I need it, I can shop for the best price. However, with health care, I have no way of knowing when or where I will get sick or injured. I have no way of price shopping for the best care, since I don’t know what I will need or how much. And there is also nothing I can do to prevent illness or injury, at least not absolutely. This is probably the key point that shows just how clueless Republicans are when it comes to healthcare. They suggest that overweight people, people who don’t work out, people who smoke and people who do drugs will always be a bigger risk and should pay more than others for health insurance. However, I had a great uncle who never weighed less than 300 pounds his entire adult life and a grandmother who chain-smoked Camels and both of them lived to be 87. On the other hand, I had an aunt who always ate healthy, never weighed more than 120, never smoked or drank and she died of lung cancer at the age of 52. How many pop stars who seemed healthy and died very young, while Keith Richards keeps on going and going, like the Energizer Bunny.

I know these are anecdotal, but that’s the point. Healthcare is anecdotal. You have people like me, who hasn’t needed a doctor in many years, and you have others, who can’t stay out of the hospital. Healthcare is anecdotal. How many people in your life have simply dropped dead, or contracted some horrible illness, when they were fine the day before? How many people contract illnesses because someone sneezed on them in a public place the day before? How many people have contracted a serious illness because some genius anti-vaxxer decided their irrational fears gave them the right to put everyone else at risk by not vaccinating their kid?

Likewise, you can’t treat health insurance like a market-based product. What the hell does a health insurance company do, anyway? You give them a ridiculous amount of money every month and, when you get sick, they pay your bill. Why do we allow these people to make a profit? What do they actually do for it? Oh, sure you can make a case that they keep the doctors honest by making sure they don’t sate the money in the pool, but until the Affordable Care Act came along and prevented it, the method they usually used was to deny payment, thus giving healthcare providers a rationale for denying treatment. We all know someone who, under the old health insurance system, was denied treatment for something because the insurance company refused to agree to pay it. In one case, my mother almost died 10 years earlier than was the case.

There is a dire need to cut healthcare costs. However, there really is only one way to do that; it’s to make sure that everyone possible is paying into the system. The real strain on the healthcare financing system comes from the sheer volume of people who get healthcare but have no way of paying the bill. When a hospital provides tens of millions in service to people who can’t pay the bill, they have no choice but to spread that loss around to all of the people who have insurance and can pay their bill. That is where health inflation comes in.

That is what the Affordable Care Act begins to address. By making insurance more affordable and helping more people pay for it, more people are paying into the health insurance system and more people’s bills were being paid. This is something Republicans can’t even fathom. Listen to their rhetoric about “other people paying their healthcare.” That is clueless. Unless you are one of those lucky people with $1 million or more in the bank, you have insurance. And if you have insurance, by definition, someone else is paying your medical bills. I mean, duh.

There is no way the GOP can improve healthcare because they operate under the delusion that this is a market-based system and it’s not. It can’t be. They see all spending as spending, and never as investment. Whereas the ACA saw health insurance as an investment, Republicans can’t see any spending as that. That is why all of their bills lop off 22-24 million off the health insurance rolls. They see the cost savings in the short term, but they are incapable of seeing it as a negative investment that will end up costing everyone with insurance a hell of a lot of money.

Forget the cruelty of taking health insurance away from tens of millions of families; when that happens, he costs for everyone who is left will skyrocket because fewer people will be paying into the system. That means fewer people will be able to pay their bills and everyone else will have to pick up the slack. It’s financially irresponsible and does the opposite of saving money. It will cost everyone a ton of money and we will be back to the broken system we had before the ACA.

Also published on Medium.


The Fiscal Irresponsibility of #Trumpcare — 2 Comments

  1. The GOP has been soliciting health care horror stories, and the time has come for me to share mine.

    Back in grad school I had a friend who today would be classified as a Libertarian. He would routinely puke up red hot hairballs o’ fury that the school required him – as a condition of matriculation – to purchase health insurance. The minute he graduated and set himself up as an independent contractor he chucked the insurance and marched along, trusting to his youth and good health to keep him safe.

    • Out of the blue – totally unpredictable, as Milt observes – a hit & run driver mowed him down on the street and left him to die, uninsured and broken in just about every bone in his body.

      But that’s not the horror story. As soon as he regained consciousness, his girlfriend marched a priest to his bedside and they were married. She then sweet talked her buddies in HR into backdating the wedding on the forms – hey, presto! – so this parasite upon society became fully covered. Evidently it’s OK for well off whites to game the system at the expense of us all.

      This actually happened, it’s not some dumb story about “my uncle knows this illegal who gets foods stamps and insurance and seventy grand a year to sit around and smoke dope!”