So, a professional sky-diver is in the plane, thousands of feet in the air, and is told by the crew that it’s time for his jump. Wait a minute, he replies, where is my parachute. Oh, we’ll design that for you after you exit the plane, says the crewman. Think he would be inclined to make that jump? But that’s been pretty much the GOP position on getting rid of the despised Obamacare health insurance plan and replacing it with a Republican brand on the label. For 7 years, since passage of the Affordable Health Care legislation in Congress in 2010, Republicans have been desperately trying to repeal and supposedly “replace” it with something better. Except that for these past 7 years the GOP hasn’t been able to put forth a feasible and rational plan for replacement. Until this week, when House Speaker Paul Ryan issued something resembling replacement in his proposed legislation to repeal and replace Obamacare, that no one is happy with, including a large segment of his own Republican Party.
Just to be clear, I was never a big fan of Obamacare. The legislation was way too long, detailed and cumbersome. It consumed over 2000 pages in written length from the start, which can never be a good thing.While the intent of the Affordable Care Act was admirable, i.e., to provide universal health care so that even the poor could receive quality medical treatment when sick, the methods devised under Obamacare were just too bureaucratic and crushing to function smoothly. Too many hoops had to be jumped through to make it work. The most rational method of providing medical treatment to all Americans regardless of their financial circumstances, would have been to establish what’s called a single payer system, run by the government. A system that every first world country on the planet already employs. Except us, of course.
Under single-payer, if you get sick, you visit the doctor or hospital of your choice. Same thing if you need a medical check-up. If you have a toothache or need a cleaning you make an appointment with your dentist. No insurance to buy, no forms to fill out. The hospital, doctor or dentist would then submit the bill to the government for services rendered. The government would then turn those bills over to designated insurance organizations who would reimburse the health professionals performing the services in question. No fuss, no muss. A system, as I’ve said, used in Canada, and throughout almost all of Europe and Asia. But how would we pay for all of this without levying harsh new tax burdens, you might ask. Again, not a problem.
The way its done in those countries embracing universal health care is to establish about a 5-10% value-added tax, which is like a sales tax on manufactured goods, usually at each step of the manufacturing process. Won’t this add significantly to the cost of purchasing such products? No, not really. While the actual cost of manufacture may increase, these costs would be more than off-set by U.S. companies not being required to offer health insurance for their employees. The savings to companies in no longer providing health coverage for their workers would be dramatic and probably exceed the increased costs of manufacture. That’s why, for example, Japanese auto companies such as Toyota and Nissan can often out-compete their American counterparts such as G.M., Ford and Chrysler. They incur no health insurance costs.Today about 190 million Americans receive their health insurance from the companies they work for. That huge burden on U.S. commerce would be lifted under a single-payer system.
But, of course, legislating such a simple health care system would be far too rational for the U.S. political arena to cope with. Instead, the Ryan plan’s replace part of “repeal and replace” mumbles something about providing “tax credits” to those too poor to afford health insurance premiums. Never mind that nearly half the country pays no income tax. I suppose that some sort of negative tax system would have to be established, similar to the Earned Income Tax benefits that now go to low income wage earners. And even these would phase out in about 2 or 3 years. The very heart of Obamacare that has had the Republican establishment so upset all these years, is that it provides the poor with cash subsidies that enable them to purchase health insurance. As flawed as the law is, about 20 million people who previously had no health plan, have signed on to Obamacare since its enactment, many through Medicaid. But a large part of the GOP establishment is dead set against health care subsidies and enhanced Medicaid enrollments. A group of about 50 GOP hardcore right-wingers in the House are calling the Ryan plan “Obamacare Lite” and are refusing to support it, because it provides some minimal subsidies. Some Republicans in the Senate are also unhappy. After all, they reason, the poor are used to getting the short end of the stick anyhow. What harm would there be with another poke in the eye. The fun just never ends.
One other thing. Our esteemed President Trump, (that phrase still claws at the very fabric of the universe) made some comment the other day that he didn’t know that health care could be so complicated. Who knew? Who knew that water insists on running downhill instead of uphill? Who knew that the sky was blue instead of orange. Who knew that standing in the rain without an umbrella will get you wet? Who could know such things?