The Bill of Ill

I consider myself to be very lucky because, pretty much throughout my life, at least one of my parents had a job that provided good benefits. Furthermore, I realize that, when I graduate, I most likely will not have much trouble finding a similar job myself. Even if I don’t for some reason, I’m lucky enough to live in a post-Obamacare world, where I can stay on my parent’s plan until age 26, a clause that even the most draconian Republican attempts at healthcare reform don’t touch.

But most people aren’t like me. For many of us, having health insurance is a luxury. Particularly before 2014, buying affordable, high-quality insurance on the private market was challenging, and almost impossible if you were poor. Particularly if you were not poor enough to qualify for Medicaid, but not rich enough to afford good insurance, many were stuck with either no insurance at all, or plans they couldn’t really afford that covered very little. Never mind if you had a pre-existing condition. In that case, well, good luck.

Not only does this situation present an obvious moral crisis, it also presents an economic one. Historically, despite spending far more on healthcare than many other developed countries, the U.S. still had poorer health outcomes overall. Left unchecked, healthcare spending is projected to only grow, particularly as the Baby Boomers grow older. Clearly, we’re reaching a point where the U.S. healthcare system, in addition to producing poor outcomes, is not economically sustainable.

There’s a possibility that Obamacare slowed both those trends, but, if so, it will most likely prove to be a temporary band-aid rather than a long-term solution. Here’s what we already know about Obamacare’s effects, though: 20 million fewer people are uninsured. Clearly, that’s a solid first step to solving the problem. Furthermore, it’s pretty clear that the expansion of Medicaid, another crucial part of Obamacare, has provided insurance for many people who would have essentially had no options otherwise. All this has been accomplished so far without costing the government a massive amount of money.

That first step, however, begins to look less solid upon further investigation. For one, many people who now have insurance have plans with high deductibles. To be fair, some of this trend seems to have started before Obamacare went into effect, but it seems reasonable to consider this something that “healthcare reform” should have fixed.

So, is Obamacare a “disaster,” as Trump said? I think that’s being overly dramatic. But it’s still clear, to me at least, that Obamacare isn’t the ultimate solution. As we’ve seen so far, it seems to have replaced uninsurance with underinsurance to an extent that is less than ideal. Furthermore, the system set up under Obamacare is strange and complicated. Ordinary citizens still have to jump through more hoops than they should to get healthcare, and the system still seems more beneficial to insurance companies than to those insured. Furthermore, the whole thing is dependent on the whims of the market and federal legislators, creating a system that’s been plagued with premium increases and decreased competition. Furthermore, it doesn’t take an economics degree to realize that Republican’s talk of withholding subsidies is probably accelerating these trends, as insurance companies become skittish. Then again, if your goal is to kill the law, I suppose that sabotaging it and then claiming it’s collapsing on its own is not a bad strategy.

Trump claimed not only that he can replace Obamacare, but essentially that his replacement will provide good healthcare for everyone. Of course, we all knew he was full of crap the minute that statement left his mouth, but it’s worth taking him seriously for a moment, considering that the future of the country’s healthcare system is in his hands. Could Trump improve Obamacare if he wanted to? I think the answer is certainly “yes”. There are obvious ways in which Obamacare could be overhauled. The individual mandate, for instance, is weak, and we need better incentives for healthy people to buy insurance. Or, if you really wanted to fix the system, you could just chuck it all out and replace it with “Medicare for all”, a la Bernie Sanders. However, we know Trump probably isn’t going to do any of that, because it goes against Republican orthodoxy, and despite running as a president beholden to no Washington power player, Trump has shown himself remarkably content to toe the party line. The closest inkling we have of something he might actually do comes to us in the form of the healthcare bill that might clear the Senate as soon as next week. As usual, it’s hard to tell exactly what Trump thinks here, because, so far, he has both praised and derided Republican healthcare efforts, but, as a president desperate for a concrete achievement, I would say that there’s a good chance that, if it came down to it, Trump would sign first and ask questions later.

Many people, of course, have written much more eloquently and intelligently than I about why the Senate healthcare bill deserves to be scrapped. I am not going to go into great detail here. At its heart, though, the bill essentially strips healthcare from the poor and lower middle class in order to hand a generous tax cut to the rich. Even if we discount the fact that it would likely leave millions of more uninsured, and that it would further negatively affect insurance markets by stripping the individual mandate, this facet alone should be damning. Just from a basic economic standpoint, this is not a bill that is going to help Trump’s core constituency, in fact, this is going to do serious harm to them. If Trump had any sense at all, there is no way he would be getting near this thing with a 6-foot pole, let alone a 6-inch pen.

And yet, the bill remains, as of now, much more unchallenged than one would expect. As usual, I would like to place part of the blame on the media, as I often do. Only recently has coverage of the healthcare bill, and frank assessments of its effects, actually started appearing in headlines and on TV. Part of this is because the process of passing the bill, a so-called “procedural” story, is not something that makes for good news items. This is simply a type of thing that the news media is really bad at covering. Not that the Senate has been particularly helpful on this front; drafting the bill behind closed doors, ramming it through before the expected outrage can be mobilized, and delaying the unpopular provisions enough that they can avoid taking political responsibility. But still, this is such a momentous piece of legislation, which could affect so many people, that it is the news media’s job to make sure citizens are aware of it, no matter what takes. Freedom of the press should be a two-way street: We give you leeway, but we expect that you inform us truthfully and accurately, instead of just showing us kitten videos.

Of course, I still think the likelihood of this bill actually becoming law are relatively low. However, that doesn’t mean that attempts at Republican healthcare reform are over. Clearly, we need an alert, attentive, news industry to expose these “mean” bills for what they are.

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