Health Care Debate: How About a Small Dose of Honesty?

I see in this evening's news that today, as promised, the Republican-led House of Representatives voted to repeal the Obama administration's health care law, the "Affordable Care Act". The Republicans' "Repealing the Job-Killing Health Care Law Act" passed on a vote of 245 to 189. The bill will go on to the Democratically controlled Senate, where in all probability it will not even come to the floor for a vote but, if it does, will almost certainly be voted down, and that will be the end of that. But in the unlikely event that hell does freeze over, the President will veto it.

So what are the Republicans trying to communicate with this stunt? Well, here are a few things that they apparently want:

• Suppose you have no health insurance; maybe that's by choice (more on this topic below), maybe not. But whatever the reason, if you were not insured before, and you have some pre-existing health condition, a prospective insurer should have the right to deny you coverage on that basis alone. (The Affordable Care Act prohibited this immediately for children and prohibits it for adults starting in 2014.)
• If the cost of treating you for some illness or condition crosses some threshold, your insurance company should not have to continue covering that cost; from here on out you are on your own, so goodbye and good luck. (The Affordable Care Act bans lifetime caps on coverage. Annual caps are limited starting immediately and completely banned starting in 2014.)
• If you have an individual policy, your health insurance company should be able to rescind coverage if it finds that you omitted or misrepresented information on your insurance application, regardless of how sick you are, regardless of whether that misrepresentation or omission has anything to do with your present illness and regardless of whether you misrepresented or omitted information deliberately or inadvertently. (The Affordable Care Act prohibits rescission except in the case of fraud or intentional misrepresentation of a material fact.)

Of course there are a lot of other things in the new health care law besides those three items. I've just picked out a few that I especially care about. I care about them because they say something about the kind of society we want to be. They say that either we think that access to affordable health care is a basic human right, or we don't. Now, to his credit, House Speaker Boehner says he wants congressional committees to design "common-sense reforms" that will increase coverage and reduce costs. Certainly there is room for improving the health care law. The parts regulating employer-provided health insurance, for example, strike me as pretty convoluted and confusing. But the Republicans did not begin this campaign by introducing proposals for incremental improvements; they led off with a symbolic effort to jettison the whole thing, while collectively making noises about how they will use whatever tricks they can to make sure it dies a death by a thousand cuts.

I personally do happen to think that affordable health care is a basic human right. I would venture to say that by and large, that is the consensus in every other modern industrial country I can think of. People in Japan or Denmark or Canada or Germany find it very hard to wrap their heads around the notion that in one of the wealthiest nations on earth (ours), a serious illness or severe injury leads a considerable number of its citizens to financial ruin every year. To wit: A 2009 study in the American Journal of Medicine found that 62.1 percent of bankruptcies in 2007 were the result of medical problems. A Fox News summary of the study's findings stated additionally, "More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts". That may leave you cold, but I find it pretty shocking.

I understand that providing affordable health care for all may very well mean that many may pay more for their coverage, at least in the short run. Maybe in the long run too, but I am not convinced that that must necessarily be the case. Improved access to preventive care and treatment for conditions in their early stages may reduce the cost overall by eliminating the need to treat conditions only when they have reached an advanced and much more expensive stage. But obviously it remains to be seen whether that will be the case. So maybe we shouldn't even look at the problem from an economic perspective; we should look at it from a perspective of whether this is the moral thing to do.

We can combine practical and moral perspectives and ask whether the way we provide health insurance in this country makes sense. You don't have to advocate a UK-style single-payer system to ask why this should be a business like any other. Regulate health insurers such that they can make a decent but not excessive return on investment and audit them as to how they are spending the premiums they collect in order to provide a nationally standardized minimum level of coverage (and simultaneously regulate how health care providers are compensated). Germany does this as part of their national health care program and in that country of around 80 million there are dozens of health insurance carriers and all of the Germans I know (anecdotal evidence, I know, but I am not talking about just two or three) are pretty satisfied with the level of service they get. But wait, that's socialism, so never mind.

We can also approach this from a specifically American perspective and expect that people take some responsibility of their own by requiring them to purchase health coverage if they have the means to do so. Wait, what did he say? That's American? Republicans have loudly opposed the mandate stipulated in the Affordable Care Act that individuals who earn more than a certain amount purchase insurance and indeed, it looks like the Supreme Court will soon be ruling on that. Republicans argue that it is not right to interfere with the choice of the individual to buy or not buy insurance. All well and good, but then let's be consistent. Tell that 24-year old construction worker who shows up in the emergency room carrying the three fingers he just accidentally sawed off with his circular saw that his choices are to show his proof of insurance, put down cash or a credit card or sew them back on himself. Never mind that he's young and thought he was invincible and, until this happened, never really understood the benefits of allocating a certain portion of income to prudent investments in risk mitigation. After all, we don't want to live in a nanny state, do we?

It is unsurprising that the House Republicans would call their bill the "Repealing the Job-Killing Health Care Law Act." Jobs are the thing on everyone's mind these days, after all, so let's just claim that anything we don't want will destroy jobs. Too bad the connection made between job losses and the Affordable Care Act is pretty tenuous and relies on a discredited interpretation of an analysis by the Congressional Budget Office. But of course, few people are going to invest the three minutes it takes nowadays to research the actual evidence behind the sound bite. Boehner & Co. know that, which is why they are investing their political capital in slogans and scare tactics rather than in policy arguments that merit any serious debate. They also recognize that time is of the essence here; the more time the broad public has to get acquainted with the benefits of the bill, the more support it is going to garner, a trend that may already be in progress.

Here's an idea: Why don't the Republicans just come clean and admit the obvious—they simply do not accept the premise that affordable health care is a fundamental human right. Let them affirm their apparent belief that health care is just one more good to be bought by those who want it and can also afford it, and to be sold in whatever manner ensures the highest possible return on investment to those who sell it. I don't see them putting any serious policy proposal for achieving the goal of affordable health care on the table, so why don't they just come out and say that this is not a priority. (And to be clear, repeating the mantra of "just let the free market work" is not a serious policy proposal here, since an unregulated market leads to exactly the kind of situation we have now, in which no rational market actor would voluntarily take into the insurance pool those individuals who are guaranteed to prevent maximization of returns.) So if there is no credible/feasible alternative solution on offer, for my money the only logical conclusion is that no such solution is considered desirable.

So just come out and say it: the Republican party does not feel that Americans have any inherent right to affordable health care, and pursuing it should not be a national priority; maybe it would be nice to have, but the party's consensus is that there are more important things on which to spend our time and money. Let's have an honest debate about that instead of wasting our time on ridiculous theatrics and pointless debates about red herrings.