Kicking a Dead Horse

With the changing of the guard in America’s political arena, the future of our health care is in limbo. Trump’s election has thrown us a wild card. It remains to be seen how that card will be played, but let’s take a look at the game.

Trump has declared war on the Affordable Care Act. In a recent interview on 60 Minutes, he declared “Obamacare’s going to be repealed and replaced. Obamacare is a disaster.” Later on, he vowed: “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.” But intentions are one thing and following through with the United States Congress is quite another. Although Republicans in the Senate have already pushed through a budget blueprint that would set the stage for early demolition of the ACA, thwarting a Democratic filibuster by means of the vote, the Democrats are not giving up without a fight. But are they defending a system that is already gasping for breath?

When the then President Elect was asked, “Who pays for the new reforms?” his response was, “The government’s gonna pay for it.” Ordinarily I just chuckle at this sort of unbacked assumption that Trump is prone to make, but this time I had a nagging sense that I’d heard those words before. This was the same belief held by millions of newly insured citizens when they signed up for health care in 2014.

Like many others who lived without the safety net of insurance, I was thrilled when Obamacare burst onto the scene. As a freelance writer and artist, I’d never been able to afford coverage. Suddenly, someone had my back. When something went wrong, instead of feeling helpless dread, I could simply pick up the phone and call my doctor. If my appendix burst, I would not lose everything I owned to pay the hospital bill. But like the millions of others who’d received this great gift, I never stopped to wonder where the money was coming from. Recently, a friend of mine who has been part of the medical community for 25 years clued me in.

First, the Affordable Care Act is funded in part by the penalties imposed on those who do not sign up. This means that not only don’t they get to go to the party, they still gotta buy drinks for everyone who does. And this is just the beginning of a lengthy list of new or increased taxes and fees that were thrust upon both individuals and businesses in order to fund the ACA. Medicare tax rates went up, $60 billion in new annual fees were levied on insurance providers and $32 billion in new taxes were tacked onto annual policies costing more than $10,200 for an individual or $27,500 for a family. Then $210 billion came from a tax on investment income for people earning over $250,000 a year. Manufacturers and importers of branded drugs and medical devices collectively saw fees raised by $47 billion, and a great number of these costs were defrayed by passing them on to consumers. Additionally, many doctors, my friend included, took a hit. They agreed to lower reimbursements to offset the burgeoning cost of care.

There are those who believe that none of those taxes were necessary, that it was all a series of moves by Republicans to make the Democrats look bad. But today, even many supporters of the Affordable Care Act now question its long-term viability. One of the problems is that the patients who initially signed up had higher medical costs than expected, perhaps due to years of neglect. At the same time, many young and healthy people did not enroll. The insurers who misjudged the risk pool and priced their products too low took a beating and a number of commercial insurers have already pulled out of the market.

There is no question that the Affordable Care Act was a godsend for many. But it has also turned out to be somewhat of a Trojan Horse for others: a load of fees and inflation disguised as a national gift. We need a plan that will work for everyone.

But whatever changes are on the way, they will not be made overnight. A full repeal of the plan would be PR suicide for the new administration, leaving millions of people without coverage. There is no clear alternative to take its place. The problems is that our healthcare system has become so complex there is no way to fix one thing without screwing up a score of others. Congress and the medical lobbyists could easily chase themselves in circles until we are all dead.

But there is one thing we all can do now and we don’t need a federally funded program in order to do it. We can simply take better care of ourselves. We all know that a healthier lifestyle is worth its weight in pharmaceuticals and surgeries. The info is out there and support is available. But not even comprehensive insurance with zero co-pays can help us if we don’t make the effort to better our lives. That part is up to us. It always has been. Don’t forget that.