Danielle McLaughlin: Healthcare nightmare could end in socialist pipedream
OPINION: "Repeal and Replace Obamacare" has been a Republican war cry since Obama's signature healthcare law was introduced in 2010. Wary of a heavy federal government hand in social welfare, and assured of the belief that markets can fix any problem, Obamacare was anathema to the sensibilities of the American Right.
The effort to repeal and replace Obamacare passed another milestone this week. The second version of Republicans' American Healthcare Act (AHCA) – passed by the House Congress with glee on May 4 – was scored by the Congressional Budget Office.
The CBO score, however, paints a devastating picture. It projects that 23 million fewer Americans – mostly the poor and elderly – will have health insurance in the next 10 years if the AHCA is enacted and Obamacare is repealed.
Obamacare was not perfect. But it sought to solve very complex problems: How to create the largest possible insurance pool of enrollees to ensure broad coverage; how to manage costs, particularly for the sick and elderly, whose care costs the most and who are unattractive health insurers; how to match premiums to the cost of living ($100 goes much further in Toledo, Ohio than it does in New York City); how to prevent costs from skyrocketing, depleting federal and state coffers; how to reduce the number of personal bankruptcies due to medical bills – some 600,000 a year.
Obamacare was actually modelled on a plan created by the conservative, Washington DC-based Heritage Foundation, and a state-wide health insurance plan enacted by Republican Mitt Romney when he was Governor of Massachusetts. We called it Romneycare.
I lived in Massachusetts for nine years. As a legal immigrant but non-citizen, I was not eligible for the programme. In 2009, as the start date of my first job out of law school was pushed back by weeks, and then months as the Great Recession unfolded, I couldn't afford to buy health insurance. So I went without it for nearly a year. If I got sick, I just didn't see a doctor. If I'd been in a car accident, it would have bankrupted me.
And bankruptcy brushed far too close to a law school classmate whose job as a state prosecutor was also left dangling by the Great Recession.
Diagnosed with a brain tumour, she had applied for but not yet been accepted into Romneycare. I clearly recall visits to her, pre-op. Her sunny hospital room belied her terrifying diagnosis. And the shadow of financial ruin sat like an unwelcome guest at her bedside.
By a stroke of administrative luck, the existence of her application ensured healthcare coverage. She left hospital following successful brain surgery with more than $100,000 in medical bills. Romneycare covered them. Without it, that brain tumour would have bankrupted her.
Obamacare didn't deliver everything it promised. Wildly unpopular, Democrats lost control of the House in 2010 because of it. The healthcare law became an albatross around Democrats' necks – it contributed to their loss of the Senate in 2014, and the presidency in 2016.
But Obamacare's failings were partly attributable to the actions of Republicans. Almost all of the 19 states that refused to expand Medicaid coverage to their working poor under Obamacare are headed by Republican governors. The day after the law was passed, a tsunami of lawsuits questioning the funding and rules of the programme began, creating instability and uncertainty for health insurers who could not know if they would be paid for covering participants in the program.
While Obama was still in office, House Republicans symbolically voted to repeal Obamacare more than 60 times. It was sabotage, pure and simple.
This week, there are horror stories being told by the AHCA CBO score. A 64-year-old with an annual income of $26,500 would pay $16,000 for healthcare annually (compared to $1700 under Obamacare). A cancer patient would see increased costs of between $28,000 and $140,000. A woman having a baby with an uncomplicated birth would be on the hook for a surcharge of $17,000. And now, Obamacare is more popular now than it has ever been – as Americans seek to shield the current law, as flawed as it is, from a disastrous replacement that strips away the system they have become accustomed to.
Democrats, who have considered single-payer healthcare in private for years, are increasingly emboldened to talk about it publicly as a viable solution to America's healthcare woes, and not some socialist pipedream.
America remains the most expensive place in the world to get sick. A place where illness or an accident can be financially ruinous. America's social safety net is thin and unravelling. And as much as the American credo is self-sufficiency, a government must ensure that its vulnerable, sick, and poor are not left behind in the raw pursuit of economic goals. As John F. Kennedy said, "if a free society cannot help the many who are poor, it cannot save the few who are rich."
If Republicans cannot work with Democrats to improve Obamacare. If instead they tear it down and replace it with a dystopian horror movie, they may not only face defeat in the 2018 mid-terms, they may force the hand of the American people to start considering single payer – that socialist pipedream – as reality.
Follow Danielle on Twitter: @MsDMcLaughlin
- Sunday Star Times