This was what the House GOP said they wanted in the last Congress:
“Reduce costs, reduce taxes, take away the “individual mandate,” but still ensure people that want healthcare have the ability to purchase it”
The whole problem, succinctly stated, in one clever, incoherent sentence.
The reason the Republicans can’t crack this nut, in fact, the reason their party won’t exist as a single party by 2024, is that they are divided and unable to be reconciled over the contradiction so ably stated above.
“Ensure people that want healthcare have the ability to purchase it”
Let’s break it down.
Nobody “wants” “healthcare” (whatever that is). I suppose the author of the sentence means “health insurance”.
People either need health care (meaning, hospitalization, surgery, medications, doctor visits, Xrays, MRIs, and nursing services), or they don’t. WHEN they need it, they want it (or are too sick to know they do), but when they don’t need it, they most certainly don’t WANT it.
When people NEED hospitalization, surgery, medications, nursing services and all the rest, (and notice how much people don’t want to think about that - they invented the euphemism “healthcare” to describe it) - when they need it, “having the ability to purchase it” is absolutely, totally, 100% completely the last thing on their minds. So is organizing society so that it will be available. What is on patient’s minds at the point of need is death, or life - disability and disfigurement, or recovery. They do not know, or care, who pays, or how.
So, the Democrats have resolved the philosophical question that comes before the practical problem. They want to ensure that “healthcare” (by which they mean services) is given to all by the government without regard for ability to purchase (pay for) it.
Whether this is right or wrong, smart or stupid, practical or akin to skittles from unicorns is not my point. My point is that they have resolved the contradiction embedded in “lower costs, lower taxes, no mandate, ensure ability to purchase (pay for it) for 100% of the population”. The Democrats know what they want, and they are united and determined to have it.
The poor, stupid Republicans, OTOH, are divided about the underlying premise. They really do want health insurance to be cheaper without the lost revenue being made up by taxes, and they want no requirement to have it, BUT they also want “people that want healthcare” (again, whatever that means) to “have the ability to purchase it”.
This is incoherent. If hospitals, surgeons, drug manufacturers and nurses do not get paid for their services, they will no longer be available. Many, many people who NEED (and therefore “want”) those services cannot pay 1% of what they cost.
“Ensuring that people that want healthcare have the ability to purchase it” either means cheap insurance that doesn’t cover anything OR nationalization of the resources to deliver care to those who cannot, or will not, pay.
There is no middle ground. The Democrats know what they want. The Republicans don’t.
As Sun Tzu said, “It is said that if you know your enemies and know yourself, you will not be imperiled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperiled in every single battle.”
The Republicans do not have a plan because they do not have a philosophy that can support their opposed goals of more freedom for the well and perfect security for the sick.
By way of metaphor, let's look at "haircare" and "autocare" instead of healthcare.
When I was a child, I remember that going to the doctor for a checkup or a vaccination was a point-of-sale transaction, like getting a haircut or a tune-up. Insurance wasn't needed to cover the cost. Something more serious, like a broken bone from a fall or a fender-bender, might have required a payment plan (or credit cards), but not insurance.
Something more serious that required hospitalization, like having tonsils removed, would be more costly. Some things, like a tonsillectomy, might be more expected in young children and not something requiring insurance (partly because the timeframe is so short and the costs still relatively low), but an unexpected event like appendicitis would be a better candidate for insurance. Even then, known childhood diseases like measles, mumps, and chicken pox, should be handled through payment plans, not insurance, again because most children are expected to get this before they turn 10.
Severe care, like a heart attack, would be a better thing to cover with insurance, as it is significant but unlikely to happen to any single individual. This would be like getting into an auto accident -- nobody expects it but they can't entirely prevent it from happening.
Then there is catastrophic care, something that is long-term and potentially fatal. Cancers, diseases, and traumatic injury would fall into this category. Insurance should be purchased to cover the costs of long-term care for highly costly but low likely conditions.
What Republicans should do is propose a free market where basic care is again affordable as a point-of-sale purchase. For basic needs, competitive pricing directly from doctors should be available. Doctors can offer "family plans," where a fixed price covers a family for a year of routine care. Extended care packages could be offered for families who want more, like outpatient care after short-term hospitalization, should it be needed, or more frequent visits (first broken bone free?). Families who have an established relationship with a doctor over the years shouldn't worry about "pre-existing conditions," as annual renewals should cover another year of health care needs.
To take this to the next step, local physician health care could be treated like mortgages; by a 15/30 fixed or ARM plan, and let it be traded by the patient or doctor if they move or the doctor retires. This can also cover pre-existing conditions, as the patient has a "title" to coverage based on an amortized payment plan.
True health care insurance should be limited to high-cost, low-likelihood events, not routine care coverage. Heart attacks, traumatic injury, sudden intensive illness, are candidates for this coverage, and is separate from local physician plans.
Finally, we have the case of the poor and the long-term terminal care. There will always be the irresponsible poor, and there will always be end of life elderly care. The poor mostly need coverage for basic care, but the elderly will need long-term managed care for several years. It could be debated that this specific category of health care could be funded by taxpayers via the federal government, if not through the states. For the poor, local hospitals could submit vouchers to the government for reimbursement. For long-term catastrophic or elderly care, the government could run facilities like they do for veterans care.
I know the arguments against government care are many, including 1) it's not in the Constitution, 2) government can't run any bureaucracy efficiently, 3) government can't run any bureaucracy competently, 4) look at the VA for proof, etc. I think it's worth a look at what the true numbers would be if the demand on government were off-loaded as stated above, and limit the government to only truly poor and elderly care, leaving the rest to the free market.
Congress has gotten itself "stuck on stupid" with the evolving desire for "omnibus" or "comprehensive" solutions. Obamacare, like Hillarycare, as well as recent failed immigration reforms, are prime examples. Republicans should try to change the narrative away from one-size-fits-all government solutions, and try to push most of it back into the private sector free market with local physician and hospital solutions, leaving catastrophic care and safety nets for the poor for the government to address.
-PJ