What’s in the Trump/Ryan Healthcare Bill?
Michael Bihovsky contrasts the Affordable Care Act with American Health Care Act. He explains how Donald Trump and Paul Ryan’s new healthcare bill takes the greatest weaknesses of Obamacare and either makes them worse or ignores them entirely.
This week Donald Trump, Paul Ryan and the Republican Congress unveiled their new healthcare plan. Now I swear to God, I really wanted this to be a good plan, I really don’t care who comes up with an idea if it actually leads to better healthcare options, and the Republicans now have a genuine opportunity to make the system better. But this bill doesn’t make things better, it is absolutely guaranteed to make things worse, because it takes every problem with Obamacare and blows it out of proportion. This plan cannot succeed, because it is made up entirely of self-destruct mechanisms.
Now, in order to understand why this new bill is so bad, we first have to go through the problems there are with the Affordable Care Act, otherwise known as Obamacare. And to clarify, I’m a huge proponent of the ACA, I canvassed hard for it, and I think it’s a step in the right direction. But everyone admits that it has problems, and they’re big problems, and we need to understand those problems because this new Trump Paul Ryan bill either does nothing to address those problems, or actively makes them worse.
The most major problem with the ACA is that despite being called the “Affordable Care Act,” a lot of people’s premiums have continued to go up. Liberals don’t like to admit this, but it’s true. And although most experts agree that they would have gone up even more without the ACA, that’s not good enough, and it’s not what we were promised. One reason costs have continued to rise is because of the pre-existing conditions clause that means you can’t be denied coverage or have your rates raised just because you’re sick. And pretty much everyone agrees that clause is a good thing, the whole basis of insurance is that sickness or injury could happen to any of us, and that’s when you need healthcare the most. But it also means that a lot more sick people now have insurance, and therefore the average premium goes up.
The way the ACA paid for these extra costs was to require everyone to sign up for insurance or pay a fine, and to provide subsidies to people with lower incomes to help them pay for insurance. And for many people that works, my premiums and copays went down 80% when I signed up for Obamacare. This new bill gets rid of the individual mandate, the requirement for everyone to buy insurance, and instead puts into place a non-continuous coverage penalty where if you don’t buy insurance, but then purchase it again, your rates will be 30% higher. Now, on its surface, I actually don’t think that’s a bad idea – I think there are better ideas, but it definitely is important to incentivize buying insurance, a huge problem with the Affordable Care Act is that not enough healthy people sign up. However, it’s human nature to respond more to an immediate threat than a hypothetical future problem. In other words, “If I don’t buy insurance right now I will have to pay a fine” is much more incentivizing than “If I don’t buy insurance right now but at some point I need in in the future, at that point I’ll have to pay a fine, but right now I’ll have extra money.” And if that future point ever comes, many people might not be able to afford it, because let’s face it, most people who don’t buy health insurance don’t do so to play a fun game of Russian Roulette, they do it because insurance is already too expensive. Making it more expensive for them down the line won’t help.
What this system of course means is that even fewer healthy people will sign up, and the rests of us will have to pay more to make up for their absence. In other words, insurance premiums will rise even more than they have already, and if you take it to its inevitable conclusion it leads to a system where only sick people will sign up for insurance at all, paying potentially thousands of dollars in premiums every month. Now obviously, most people can’t afford that, so if they’re really sick, what will happen to those people? Well, a lot of them will die. It’s really that simple. The Republicans say that people can go back to getting treated in emergency rooms, which is one reason why healthcare got so expensive in the first place, but you can’t get chemotherapy in an emergency room. You can’t fill ongoing prescriptions or actively prevent sickness in an emergency room. And if you do go to the emergency room for something sudden like a heart-attack, you’re going to have to pay full price for it, which could be hundreds of thousands of dollars since there’s no one to negotiate down for you. So the sickest people will die or go broke, and the taxpayers will go back to paying the difference, and the chronically ill will have to pay for doctors and drugs out of pocket or not get care at all. You cannot have a health insurance system designed only for sick people any more than you can have a car insurance system exclusively for drunk drivers, it doesn’t work. And that’s a terrible analogy to begin with, because drunk drivers choose to drink and drive. Nobody chooses to get sick. And yet we’re heading back to a system where they’ll be penalized for it anyway.
And as for the subsidies, the ones that help poor people pay those insurance premiums – those are gone. The few subsidies that remain won’t be based on income, they’ll be based on age. So if you’re a non-elderly poor person on private insurance, you will probably lose affordable coverage. And since 50% of adults have at least one chronic illness, that’s a huge problem. Now, you may be eligible for a tax credit to partially refund you after the fact, but how many poor people have ten thousand dollars sitting around to pay for health insurance, and can afford to get refunded to some extent one year later? Not many. This may be surprising, but the thing about poor people is: they don’t have money. This bill ignores that complicated fact. So because of this, and thanks to a cute little loophole, guess who the main beneficiaries of this tax credit will be? Rich people! The truly oppressed. They’ll benefit from this tax credit a lot, and can even use these rules to potentially put themselves into a lower tax bracket. It will also – I swear to God – give additional tax deductions to any insurance executive who makes more than $500,000 a year. Look, if you voted for these people because they were paying attention to your needs and the Democrats weren’t, I totally I get that. But at some point you need to come to terms with the fact that yeah, the Republicans paid attention – but they didn’t actually implement any of it! Unless you can explain to me why a tax break for a millionaire CEO somehow helps you to get better healthcare?
Now, the way the ACA was designed to help poor people afford healthcare was to make every state get on the new insurance exchange, and to expand Medicaid, but the Supreme Court struck down that requirement. But a lot of states, even some Republican states, went on the exchanges or set up their own and expanded Medicaid anyway, which left those states with a lot of extra costs. Problem. The way the ACA solved that problem was to have the federal government foot much of those costs. No more. And without that, the states can no longer afford these programs. So if you’re on Medicaid… very soon you might not be. To put it another way: if you like your coverage, you may not be able to keep your coverage. Sound familiar?
So those are all the poison pills that the new healthcare bill contains, but actually what troubles me more is what it does not contain, to fix the single biggest problem with the Affordable Care Act, which is that the ACA only asked the question of “How do we pay for healthcare?” instead of “Why is healthcare so expensive in our country in the first place, and how do we bring that cost down?” And because of that, these exorbitant costs have gone unchecked and unchanged, or even risen. There are many ways to cut costs, which is what I thought the Republicans were all about and why I genuinely hoped they might do something useful, but this new bill proposes nothing, not one single thing to cut the cost and waste of actual healthcare. These include Direct-to-Consumer advertising, which are all those commercials for drugs you see that spend 30 seconds whispering about how you’ll probably start bleeding from the anus if you take these drugs, and those commercials and things like it cost tens of billions of dollars per year. They spend twice as much on advertising as they do coming up with actual medicines. So if you got rid lot of pharmaceutical advertising, the way they do in every other western countries besides New Zealand, and the way it was for most of our country’s own history, drugs could be a lot cheaper! And look, if a New Zealander told you to jump off a bridge – wouldn’t you think their accent was adorable? You might even do it! But that’s beside the point. Not only do we let the drug companies advertise, we actually give them tax breaks to get them to do it more! This bill does not even bring this issue up. Another thing that makes drugs expensive is that Medicare and Medicaid are not allowed to negotiate drug prices directly, like every other insurance company can. So if a drug company wants to charge the government $1,000 for a single prescription, they, meaning we, will pay it in full. And we do, to the tune of $324 billion per year! Are you beginning to see where our budget deficit comes from? It’s healthcare! And other things, but this is a major factor. I thought Republicans hate deficits! So why are they not addressing this? How about instead of kicking poor and sick people off of their health insurance, they do something, anything, to just make it cost less?
And the list goes on and on. Allowing Americans to buy drugs and medical devices from Canada, where it’s cheaper? Not in this bill. Stopping drug companies from giving doctors cash bonuses – aka bribes – for prescribing the most expensive name-brand drugs? Not in this bill. Incentivizing the creation of generic versions of those same drugs? Not in this bill. Tort Reform, to cut down on frivolous lawsuits which makes doctors’ malpractice insurance rates insanely high, an OB-GYN pays about $300,000 a year, a total of $55.6 billion per year that Republicans have long wanted to cut down – Not. In. This. Bill.
This is a travesty. It is insulting, and it is fatal. And it is your job, whether you are a Democrat, a Republican, or none-of-the-above, to stand against it and demand something better, or at least something that works. Now this is of course not the final version of this bill, which is both good and bad. It’s bad because for the most part, the lobbyists from all the industries we just talked about haven’t touched it yet to make it even worse, as I’m sure they will do any moment now, they’ve probably started already. But it’s good because we are lobbyists too, on behalf of ourselves and the people we love. If you have a chronic illness, rise and stand against this. If you know someone with a chronic illness, please stand by our side, because so many of us cannot act in the same ways that you can to stand for ourselves. If you are a progressive liberal and believe that healthcare is a right, stop this government from restricting it even further, and demand they take actual action to make it cost less. And if you are a fiscal conservative, stand against such waste and recklessness and irresponsibility. There are very few issues that all of us can stand on the same side of anymore. And I genuinely believe that this is one of them. It’s not about saving Obamacare, if there is a bill that will do a better job than the ACA I would be proud to support it. It’s about saving any healthcare at all. Please: write or call your representatives to stand against all of these things and to demand actual progress. They will hear: and if we stand together, maybe we can even make them listen.