But the dogged partisan resort to secrecy, skullduggery and subterfuge suggests that whatever healthcare creature eventually emerges from the legislative black lagoon beside the Potomac, it is unlikely to fix our broken system or put an end to the perennial turmoil over healthcare policy. It is more likely to make matters worse.
Republicans in Congress have been saying for the better part of a decade that they want to rip out the existing well-liked and functional healthcare system and replace it with … something.
Sometimes they go so far as to say “something better.” They have never been able to articulate just what that “something” might be. And now that they are in a position to actually produce an acceptable “something,” they find it’s more easily said than done.
Recent attempts at cobbling together a replacement have had more to do with delivering tax cuts to the wealthy than with healthcare improvements. Most of the changes offered in the recent congressional plans have involved sabotaging Medicare and Medicaid, and making insurance coverage worse, not better.
That hasn’t exactly thrilled the Republican voter base – most of whom have a lot at stake here. Yet they have remained mostly loyal, and seem willing to accept whatever sadistic and unnecessary cruelties their party inflicts.
It may seem baffling that Republicans can persuade so many people who stand to be seriously harmed, to go along with the notion that denying them affordable healthcare is a good idea. But the phenomenon is easily explained:
When it comes to healthcare, Americans don’t know what they want.
Right or privilege?
Is healthcare a right?
Blogger Jim Wright asked that question a while back, and discovered something startling: Americans seem genuinely conflicted about it
Wright concluded most Americans are uncomfortable, even afraid, to try answering the question.
More than a few commenters hemmed and hawed and tried not to say they wanted healthcare for themselves and their fellows, but maybe not for everyone else – especially if that involved having to help pay for it.
The mixed bag of “Yes, but…” and “No, but…” answers Wright collected could never inform the creation of a sensible dialogue, let alone national policy.
So, is healthcare a right or not? We’ll take our own stab at answering that in a bit.
Get out of the lifeboat!
Meanwhile, the national ambiguity about right-vs-privilege has created a political vacuum the health insurance industry sees as a huge opportunity. The vacuum will be filled and it is they who intend to do the filling.
Big Insurance has allied itself in this vacuum-filling with Big Employers – read wealthy corporations and the already obscenely rich individuals looking to avoid having to kick in a dime toward healthcare in any form for anyone but themselves.
The attempt to slip out of their share of the social contract goes beyond sharing the cost of health insurance. It includes their having to pay as little as possible for, among other things, Medicaid, Medicare, Social Security, nutrition assistance for poor kids, family planning or (heaven forefend) worker retirement pensions.
They plan to commandeer the social lifeboat, do you the favor of kicking you out, and sell it as giving you the freedom to swim to any shore you please.
As the specious argument goes, universal healthcare would curtail the freedom of those who don’t want it by making them to pay for it.
Kind of like what happens with just about everything governments at every level do every day. Select any government service you don’t like paying for, and tell us how you lawfully exempt yourself.
Schools? Roads? Police? An enormous military? Weaselly gas-bag lawmakers? You and I may not be enthused about paying for them, but we do because they are part of the society we have built and choose to live in.
House Speaker Paul Ryan, one of the main architects of the various healthcare bill travesties foisted on us lately, likes to talk about how his plans will preserve “access” to the healthcare market for everyone.
His glittery words are deliberately slippery.
You currently have “access” to the market for Rolls-Royce automobiles. That doesn’t mean you can afford to own one.
“Access” to healthcare is not healthcare.
Policy based on fiction
Ryan a devout if unlikely disciple of the government-hating, resolutely selfish (and, in real-life, personally needy) novelist Ayn Rand, waxes articulate on his skewed concept of freedom.
Forgetting that he’s talking about a novel, a description of a fictional society that could not exist in the real world, Ryan fends off logic and assures us he’s only offering “the freedom to choose.”
The “freedom” to choose … what?
You are free to do without insurance for yourself and your family in an utterly unaffordable healthcare system. Never mind that everyone, including you, eventually needs healthcare.
You are free to spend half of your income – or perhaps much more – on insurance for treatment you need to survive.
You are free to go bankrupt if a serious illness visits your life.
You are free to die.
Yes. Really. That is not some alarmist exaggeration. It is the sort of callous, greedy thinking that is actually devising the healthcare policy that will govern you and your family and perhaps drive you to ruin.
By the way, Congress has exempted itself from any and all unpleasant changes it makes to your healthcare coverage. Whatever they come up with is not good enough for them but it’s OK for you.
Dirty little healthcare secret
Let’s be clear about who/what we are referring to.
The health insurance industry has a dirty little secret, one the wider American public has yet to sniff out:
Health insurance companies are not necessary.
They add only costs. They offer no price or quality advantage whatsoever over the single-payer plans in use in the rest of the world’s countries.
But they do make the American approach, which covers far less, vastly more expensive.
Health insurance companies are corporations. Like all corporations, they exist solely to make a profit for their investors.
They are not in the business of helping sick people. Healthcare is just the market they have chosen.
Like any corporation, insurance companies only want maximum profit and minimum payout, and no laws or moral folderol standing in the way.
Insurance is managed risk. It is a sort of Ponzi scheme – essentially a bet that you will pay premiums for a while without making any serious payment claims. When you inevitably do file a claim, money from others in the coverage pool will be used to pay you.
When insurance company payouts begin to eat into profits, the company raises rates and/or dumps its most expensive customers.
Guaranteed quality coverage
The Affordable Care Act – much reviled by Republicans as “Obamacare,” attempted to address the inherent instability of the health insurance market.
Obamacare is not insurance. Did you know?
That’s right. Obamacare is not insurance. It is a swindle-free competitive marketplace where you can buy guaranteed-quality insurance offered by private insurance companies.
ACA coverage is not provided by the government. It’s not free. Everybody pays. Some get subsidized rates but nobody gets a handout.
ACA eliminated the need to compare the fine-print gotcha language and the deliberately confusing legalese and the bewildering variations in coverage. All ACA-grade insurance policies cover the same things. They compete on price.
This is revolutionary in the American experience. The ability of private individuals to buy guaranteed-quality health insurance at a competitive price is something that simply did not exist before ACA.
The key to making this approach work is the mandate: Requiring everyone to buy health insurance, or at least contribute to the coverage pool.
That sort of universal coverage creates a stable, predictable customer base and spreads the risks among the sick and the healthy alike.
Yes, the healthy help pay for the sick. But today’s healthy are tomorrow’s sick; younger healthy people will arrive to help care for the infirm as they age. It is part of that social contract, a fundamental ingredient in making America the great nation it is.
Is this not the best of all possible worlds? Everyone is covered, markets are stable and guaranteed. With every company’s policy meeting the same basic level of coverage, profits are just be a matter of offering good pricing and controlling costs.
Further, under the ACA system, the continuing role of insurance companies is assured in perpetuity.
ACA is, in its way, an insurance policy for insurance companies – immunizing them not just against the threat of single-payer coverage but against abuses by companies that could produce a backlash, a public uprising of such fury that it could scatter their lucrative racket to the four winds.
But the insurance companies don’t see it that way.
A swindler’s paradise
Remember, they are corporations. The corporate CEO’s bonus is tied to ever-increasing profits. Nothing but the ability to send quarterly numbers limitlessly soaring by whatever means necessary is ever enough for corporations.
So to hell with all that talk of stability and affordability and fairness and making sick people well. Insurance companies want to return to the old days, when healthcare was rationed and the marketplace was a swindler’s paradise.
Customers could again be bamboozled into buying policies with deceptively low premium rates that cover next to nothing. Or they could simply be priced out of quality healthcare verage.
Companies would go back to making sure profits stayed high and rising by enforcing bewildering authorization rules, maddening and dangerously long reimbursement delays, confiscatory co-pays, impossibly high deductibles, and lifetime benefit caps.
MRI scans, a now-common diagnostic tool, can cost $13,000 or more, depending on where they are done.
A heart pacemaker, a device that spells the difference between life and death for people who need one, can easily cost a quarter of a million dollars, not counting the absolutely necessary regular follow-up care for the rest of the patient’s life.
If you aren’t familiar with what even simple medical procedures cost, it is understatement to say you might be in for some sticker shock. That lifetime healthcare insurance cap could evaporate faster than the beer at a stock car race.
In a cynical attempt to deceive people, authors of the healthcare bills would include language that makes it seem things are covered. Cancer treatments? Covered under the federal law. Same for pre-existing conditions, etc.
What they don’t tell you is that states can be granted waivers, literally for the asking, granting them the power to allow healthcare insurance policies to exempt cancer drugs or pacemakers, or any specific medical treatments, from coverage.
Hey, don’t blame Congress for what the states do!
One especially deceptive Senate proposal currently in play would allow insurance companies to go back to selling junk, as long as they also offered ACA-quality policies as well.
That doesn’t sound unreasonable until you realize the junk policies could initially be priced very low and still be enormously profitable, but because of the reduced risk pool (fewer number of customers), the ACA-level policies would be prohibitively expensive.
Smaller pool – more risk to profits – higher cost to the insured.
Do you remember the three-claim rule?
If your doctor has been around for a few years, he or she can tell you about the unwritten corporate tactic: Insurance companies would slowly process and routinely reject legitimate claims twice. If you or the doctor, in an unusual display of persistence, filed the claim a third time, the company would usually pay.
It was a profitable ploy. Often as not, exasperated patients, dunned by their physician, would simply pony up the fee, letting the insurance company off the hook.
If allowed to do so, insurance companies would not hesitate to bring the unscrupulous practice back.
The ACA marketplace put an end to such chiseling. If you buy insurance via ACA, you’re covered for pretty much everything.
Congress and the Trump regime have been systematically sabotaging the ACA subsidy process. The effect is to reduce the number of poor people with insurance coverage. This allows ACA opponents to point to the decline in coverage numbers and claim it is proof ACA doesn’t work.
Many voters don’t know the government is engaged in this subterfuge because many voters are, as Republican political strategist Karl Rove famously observed, inattentive but brand-loyal.
In other words, as we mentioned earlier, it seems the Republican rank-and-file will happily vote for any Republican proposal, no matter the issue – even if it is dramatically against their own best interests – as long as the Democrats don’t like the plan.
Republicans have long known this human idiosyncrasy about their base and cynically use it, to demonstrated great success.
Neither fish nor fowl
So, back to the original question: Is healthcare in America a right or a privilege?
It is neither.
Healthcare is not a right.
At least, as blogger Wright observed, not an enumerated right, spelled out clearly in the Constitution – like freedom of speech. And it is, as yet, not an unenumerated right (privacy, for example) as implied by the 9th Amendment.
And it is not a privilege.
Except in rare cases, America traditionally has not been a nation where privileges have been formally conferred on a de facto aristocracy, to the exclusion of others. That would be dangerously corrosive to the fabric of America.
We know that in practice, our society does harbor various elites, tolerates that they enjoy a certain level of privilege and defers to them in any number of ways.
Congress creating a gold-plated healthcare plan solely for itself is an example.
But we still generally subscribe to the tattered 14th Amendment concept that we are all equal before the law.
Most people think of rights as things they are allowed to do. But from a constitutional standpoint, rights actually describe things the government is not allowed to do.
You have a right to freedom of speech because the Constitution forbids Congress from passing a law to punish you for things you say.
So if healthcare is not a right and it is not a privilege, what is it?
That is what we must decide.
If we cannot agree that healthcare is or ought to be a right, and don’t like the idea of limiting it to a privileged few (the private plan for members of Congress, for example, let’s call it a benefit.
An American answer
Healthcare is a benefit of being an American.
Why not? Practically every other country on the planet offers healthcare as a benefit to its citizens.
All we have to do is choose to make it so.
This is actually a very American idea.
The answer to the healthcare dilemma has been staring us in the face all along.
Right there in the Preamble to the Constitution (that “We the people” thing folks are so fond of quoting) it says one of the core reasons for establishing the American Republic in the first place was to “promote the general welfare.”
The phrase is sandwiched between “provide for the common defense” and “secure the Blessings of Liberty to ourselves and our Posterity.”
That’s it! The Founding Fathers clearly recognized that a healthy society would be a strong and stable society.
So the phrase “promote the general welfare” of the nation’s citizens can be taken to suggest the government has a responsibility to have public policies that foster the health and well-being of all Americans.
Anyone who has known poor health, especially if the cause was a corporate or congressional policy decision, or the lack of one, understands the importance of good health to the general welfare of a society.
There has never been any doubt that the words “provide for the common defense” meant using taxes to pay for a standing army. The phrases are separated only by a comma.
So what the Deuce is the big dubiety over “promote the general welfare” all about?
Risking their future
A single-payer system could be easily accomplished. Simply lower the eligibility age for Medicare.
Insurance companies wouldn’t like that, and certainly would face some existential challenges under such a system.
It is, nevertheless, hard to imagine any other approach being better in the long term for the nation as a whole.
So the insurance industry should be careful what it wishes for.
If insurance companies insist on free rein in the healthcare marketplace, if they cannot step up and support a solution as eminently beneficial to their industry as ACA, then public opinion will inevitably boil over. Single-payer will be their future, and ours.
Michael W. Dominowski is the editor of Not For Hire Media