For the last eight years, Republicans have claimed to have a plan to improve health care.
If you didn't like the deductibles under Obamacare, they told you that their plan would lower those deductibles. If you didn't like rising premiums, their plan would lower those premiums. If you didn't like the fact that Obamacare left 28 million uninsured (in part because states such as Georgia decided to leave them uninsured), their plan would fix that too. If rural hospitals were closing, if insurers were leaving certain markets because they were too small to be profitable, the Republican plan would fix it.
Yet no such plan existed. Even worse, Republicans had no intention of having such a plan. Their "plan" all along consisted of a single paramount concept: Slash government funding for health care as much as politically possible, then divert the money saved into tax cuts targeted at the wealthy.
In recent weeks, we have seen that singular concept take legislative form. The Republican Senate version, the "Better Care Reconciliation Act," doesn't offer anything remotely like better care. It proposes to take $1.1 trillion in federal money out of the health care system over the next decade, and it replaces it with ... pretty much nothing. According to the Congressional Budget Office, that will leave an additional 22 million Americans with no insurance coverage whatsoever. "The increase would be disproportionately larger among older people with lower income — particularly people between 50 and 64 years old,” the CBO predicts. In Georgia alone, according to one expert analysis, 680,000 will lose coverage, a step likely to push rural hospitals over the brink into bankruptcy.
The theory, of course, is that the free enterprise system will take care of it. But nowhere on this planet does the free enterprise system "take care of it," because while the market does a lot of things effectively, it is spectacularly ill suited for regulating access to health care.
A functioning market, whether the commodity is sugar, salt, steel or surgery, requires that you, the potential buyer, are able to compare prices and outcomes. It requires that buyer and seller have comparable degrees of knowledge about the goods or service being purchased. It requires that the buyer and the seller are equally motivated to reach a fair deal. It requires competition.
None of those conditions exists in health care.
When the doctor tells you that he can save your life, or the life of your child, spouse or parent, you're not in a position to bargain about the price he's going to charge you. When you're wheeled into the emergency room after a car wreck, you can't interview every specialist who walks into your room to make sure they're "in network." You can't ask three different hospital groups to submit bids for your breast cancer treatment, nor can you accurately compare survival rates. If a pharmaceutical company wants to charge you $5,000 a month for the drug that will save your life, you pay it or you die.
But here’s where it really falls apart: The basic premise of the marketplace is that if you can’t afford it, you can’t have it. In this case, if you can’t afford health care, you don’t get health care. If we’re willing to do that — if we’re willing to accept the “collateral damage” of untreated illness and unnecessary death, if we treat health care as a luxury item available to some, rather than a right available to all — then the GOP approach can work, after a fashion.
The GOP has shown itself willing to do all that, and to accept that collateral damage. I’m not. I think the self-proclaimed richest, most prosperous nation in the history of mankind can do better than that.
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