Over the past few months, and especially since Donald Trump's address to Congress on February 28, it has become increasingly clear that the GOP is in the midst of a health care quagmire of its own making. Despite the Republican Party's claims to the contrary, party members have demonstrated little unity in regard to potential plans, and none of their ideas would protect the interests of sick people, poor people, people with disabilities or others who need health care coverage the most. If the Republicans repeal the Affordable Care Act (ACA), they risk taking health insurance away from 22 million people, which will sink the party's political future. But if they do nothing, they'll anger the legions of Trump voters who have been consuming their anti-Obamacare propaganda for years.
Quite a hole, but it's one they've dug themselves into, all on their own.
As far as guidance, they're certainly not getting any from President Trump, whose own opinions on health care have proven to be as fluid, inconsistent and meandering as his opinions on ... well, just about anything. While the party establishment has pushed its anti-Obamacare narrative for the better half of a decade, they now find themselves in a difficult position: 21st century Republican philosophy is fundamentally based on the idea of benefiting the upper classes of society through tax cuts, while giving as little welfare to the poor as possible. Neoliberal Republicanism, as we know it today, might make a lot of phony overtures to "libertarian small-government values" or "Christian values," but the actual philosophy of the GOP is all about socialism for the rich and cutthroat capitalism for the poor. Since Trump's voter base included many working class white voters, many of whom actually depend on marketplace plans, the act of rescinding the Affordable Care Act -- and thus taking away health care from millions -- is unlikely to go over well, unless the GOP could find a replacement that maintains their coverage (doubtful).
Of course, the GOP won't examine the possibility of true universal health care. To the Republican Party establishment, a single-payer health care system that benefits the whole of society, instead of simply their wealthy donors and massive corporations, is sacrilege. This is despite the fact that it has been demonstrated, time and time again, that the majority of US citizens are totally on board with a federally funded health care system, the "Medicare-for-All" approach that Sen. Bernie Sanders advocated on the campaign trail. But no, they say, that would be Un-American -- even though most Americans do want it. Recently, support for single-payer has even been growing.
Because the GOP's true masters are the corporate elite, they're hoping to try to pull one over on the 99 percent through their goal of so-called "Universal Access" health care, which, of course, is not actually universal at all. The term "universal access" is merely a pretty bow and shiny wrapping paper to cover up the ugly neoliberal mud pie on the inside.
The Great, Big, Empty Deception
On February 17, 2016, House Speaker Paul Ryan tweeted that, "Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs." While Ryan is certainly a more skilled rhetorician than Donald Trump, and knows how to dress his words up nicely, it's not too hard to see past the obvious propaganda in Ryan's statement. He and his GOP allies want a health care system that benefits the wealthy, by making it so that the upper class doesn't have to foot the bill for poor people, the working class, sick people and people with disabilities. They do this in honor of their god, capitalism, and the so-called "free market" -- which is a false value in the neoliberal state that the US has become. But even if a true free market did exist, instead of a fictitious one, health care rights should never be made hostage to it.
The problem with this concept is that free-market health care can't exist when "private" health insurance companies also exist, because the latter destroy the former. Private health insurance companies artificially inflate medical prices to unaffordable rates, leading to higher insurance rates, followed by higher medical prices, and so on, which is why any health care procedure in the US is so much more expensive than it is in other countries. Paul Ryan wants to paint a picture of a free market where anyone could pick any health insurance plan they want without any government interference -- and maybe he genuinely believes this -- but the reality is that health insurance companies can't work in a free-market system, because these companies only profit by taking on healthy clients. Sick clients run up their costs past the breaking point, but sick people are the ones more likely to purchase health insurance. This is why, before the Affordable Care Act, numerous people were turned down for insurance due to "pre-existing conditions."
The result is that free-market health care is a system that effectively prices out the poor, rendering them unable to getting health care services, while the healthy have free rein to pick and choose. It's not "universal access," it's privileged wealthy access.
The Republican establishment knows that this idea isn't going to go down easy if they sell it straight, so they instead use a lot of rhetoric about "universal access," and so on. The problem they have now, with their desire to amend/repeal/enhance the Affordable Care Act, is that they know that they need to preserve coverage for people with preexisting conditions, or they're going to have a landslide of fury raining down upon them. The problem here is that, mathematically, they can't preserve coverage for people with preexisting conditions without requiring young, healthy citizens to get health insurance as well, in order to fund the whole shebang, which is the reason for the (admittedly unpopular) mandate; if the young and healthy aren't required and covered, the private system won't have the proper funding. Furthermore, over 80 percent of "Obamacare" enrollees still need subsidized coverage in order to afford the high prices, and this requires the Affordable Care Act's taxes on the wealthy -- the same taxes that the Republican establishment wants so badly to do away with.
We Need True Universal Health Care
The actual solution, of course, is neither the Republican "plan" nor the Affordable Care Act; it's universal health care, the dark horse in the debate that keeps getting brought up more and more. Universal health care would actually repair the deficit, is proven to be effective and is the only thing that would truly ensure universal health care access for every US citizen.
The United States is the only developed country in the world that doesn't have universal health care, and its system is also the least effective. Despite how much Americans pay for health care every year -- having the highest health expenditure per capita of any country -- health outcomes in the US pale in comparison to outcomes in other nations, with the US having the lowest life expectancy, the highest rate of infant mortality and many other staggeringly poor figures. Nations with fewer resources, such as Thailand, have successfully pulled off affordable universal health care systems, so it's certainly not out of reach for the United States to achieve.
The Affordable Care Act has many problems, no doubt, and doesn't come close to the strides that a true universal health care system could create. But despite its flaws, the Affordable Care Act has successfully led to the end of the "preexisting conditions" problem and has allowed millions of people to afford health insurance for the first time. Now, the ACA is still deeply flawed, still gives too much to the cutthroat capitalist health insurance industry and isn't affordable enough for far too many. The changes it does make to the country's health care system don't go far enough. But unfortunately, the GOP's attempts to change the health care system will not resolve the Affordable Care Act's issues, but will instead cut away at its strengths.
The Fight Continues
This majority approval for universal health care is exactly why Republican politicians want to brand their Affordable Care Act replacement/amendment/etc. with the misleading label of "universal access" health care, hoping to tap into voters' hopes and dreams by playing on misinformation in the branding of their neoliberal product.
Needless to say, this false "universal access" concept, and the wrongheaded ideas that created it, are an empty promise. As the GOP continues to drag their feet, spout propaganda and tiptoe over what will certainly be their wealthy donor-focused changes to the ACA, it's more important than ever that people take the time to speak up and defend their health care rights, before the government takes the opportunity to leave 22 million uninsured, ignore the cries of the sick and needy, and leave the nation drowning in unaffordable medical debt.