America needs Medicare for all

It will be great! Donald Trump promised repeatedly that his Obamacare replacement would offer Americans universal or near universal health insurance at a lower cost than the Affordable Care Act.

He guaranteed the same protections for preexisting conditions and a continuation, and probably improvement, of essential services. He assured his boisterous crowds of greater access to medical services and more freedom of choice.

A show of hands, please. Does anyone believe a word of what he said?

A week ago, Senate Majority Leader Mitch McConnell, R-Kentucky, unveiled the Better Care Reconciliation Act, the drafted-in-secret Senate’s version of Trumpcare. That iteration pretty much replicates the House bill (which Trump both celebrated and described as “mean”). Under either version, 22 million Americans will lose their health insurance by 2026, 15 million in 2018 alone.

For those who still have health insurance, the policy (unless you are rich or have a good employer-based plan) would cover significantly fewer medical needs. In addition, premiums will spike, and deductibles and out-of-pocket payments will rise dramatically. Many older people will not be able to afford insurance at all.

And here is the dirty little secret that the Republicans are obfuscating as quickly as their printers can spit out their talking points: Trumpcare will result in people dying.

This is not hyperbole. Studies prove that health insurance and the resulting access to care reduces the chance of dying for adults age 18 to 64 by between 3 and 29 percent.

This should come as no surprise. Health care results in early and life-saving treatment for diseases like diabetes, depression and cancer. Indeed, the recent expansion of Medicaid in three states decreased mortality significantly.

Let’s consider a few specifics of the Republicans’ plan.

The House of Representatives’ version eliminates any requirement for insurance companies to cover preexisting conditions. This Senate bill ostensibly would preserve that coverage but then with a sleight of hand actually makes it, as a practical matter, disappear by (1) gutting the ACA prohibition against charging higher premiums for insurance for people who need and use medical care, (2) allowing states to eliminate minimum standards for benefits, and (3) permitting both annual and lifetime limits for medical coverage.

Right, both McConnell and his disingenuous House counterpart, Speaker Paul Ryan, understand that most people think it is important to be able to secure medical insurance if they have a pre-existing condition, so neither of them admit to abolishing that guarantee of the ACA. But both the House and the Senate versions do exactly that.

Under both bills, many or most low-income people will be precluded from purchasing the policies because the sticker price will be prohibitive and the deductibles will present an unmanageable obstacle. And the news for middle-aged middle-income Americans is no better. The Senate bill would, for example, leave an average 64-year-old who is earning $55,000 a year with a $20,500 annual health insurance premium and with no government help to pay for it.

Perhaps the second dirtiest secret – certainly one of the most immoral parts of these legislative proposals – is that they slash the benefits and costs of Medicaid in order to provide enormous tax cuts for the unbelievably wealthy. Really, the legislation will provide billions in tax savings for billionaires while decimating Medicaid, which covers health care for poor children as well as two-thirds of the people in nursing homes.

These proposals – with a nod to his repeated promise for a great health care plan – leave me with a few questions for Mr. Trump and his Republican minions: Who will care for those elderly in nursing homes? If they can’t stay there, where will they go? How will the disabled receive medical care? And how will the states possibly cover these costs?

The Affordable Care Act to be sure has structural and financial shortcomings. It does not offer universal coverage as Medicare for all would.

And Medicare for all is is what America needs. In 2015 the United States government spent 8.4 percent of its Gross Domestic Product for health care under Medicare, Medicaid and subsidies under the Affordable Care Act. This 8.4 percent of GDP covered only half of Americans. Compare that figure to universal single-payer coverage in Britain where the government spends 7.7 percent of its GDP for health care for all of its citizens. Finland, Canada and Italy, also with the universal single-payer coverage, spend even less.

But despite its shortcomings, which include underwriting the insurance industry, the ACA does provide coverage for tens of millions of Americans who otherwise would go without, and it mandates appropriate minimum standards for that insurance.

Under Trump’s, Ryan’s and McConnell’s plans, more than 20 million Americans will lose their access to medical coverage, and untold millions will pay more for less.

These facts lead me to a final question: Did Trump voters think this is what he meant by Making America Great Again?


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