Tuesday, June 27, 2017

The Alternative to the Republican Alternative


Health care is a hot topic these days, with good reason. It accounts for nearly 18% of GDP. It is up to an average of just under $10,000 per person as of 2015. For many people, it represents the second biggest monthly expense, after rent/mortgage (for some, it is the single biggest expense). And yes, by some measures it is woefully inefficient in the United States.

The Republican plan is attempting to reform the system by a) reducing costs, and 2) passing those reductions on to the top 1% in the form of tax cuts. I don't think the GOP is going out of its way to be cruel; it appears that the cruelty is just a bonus for the likes of Mitch McConnell and Paul Ryan.

One common buzzword that is emerging is "consumer choice." Apparently, to the GOP, more choice = better outcomes, even though this has never been the case when it comes to health care. The problem lies with the assumption that health care is a consumable service, like tax preparation or car repairs. It is not. Paul Ryan has said that the House plan "guarantees access to health care." It absolutely does, but only in the same way that I have "access" to a villa in Tuscany and a new Rolls-Royce ... there's nothing that forbids me from owning these things, but if I can't afford them then it's my own damned fault.

"Choice" is not always good. When someone has been in a car accident, or is having a stroke, or has fallen down a flight of stairs, they are in no position to research an acceptable "choice" ... they need care, and they need it fast. I realize that it has been a long standing policy in the United States that nobody gets turned away if they need care, and that is definitely how it should be. However, it is grossly unfair that someone is not turned away, only to be driven into bankruptcy because of some minuscule print on an insurance policy that says claims will not be paid if the doctor's name is Harold, or something like that.

The ACA was an attempt to make the free market behave like single-payer. In some ways it was successful, in other ways less so. Regardless, single-payer is the only way to guarantee:
  • Everybody has unfettered access to health care.
  • Nobody will go bankrupt as a result of medical expenses.
  • The amount spent on health care will actually go down.
"But, but, but," I can hear Republicans sputtering, "how will we pay for this?" The answer is easy: raise taxes.

I know, I know. This is a concept that is anathema to conservatives, and not a favorite of everybody else, but look at the math. For example, I spend roughly $6,600 a year for employer-provided health insurance (including dental and vision) for myself and my family. There are roughly 126 million people working in the United States. Assuming a conservative estimate that each person with insurance is covering another one of these working people, and that the insurance costs about the same (mine is actually fairly inexpensive by comparison -- the Department of Health and Human Services pegged the average annual health care cost per person at $10,345 in 2016), that equates to about $415 trillion dollars being spent on health insurance each year. Compare that to the $110 billion being spent by the federal government to support the ACA.

Now, let's say we needed to fund single-payer health care, and we do so by raising taxes to cover the anticipated cost of $1.34 trillion over the next decade for the ACA, or $134 billion per year. To do this we would have to raise taxes on every working person in the United States by an average of $1,064 per year, or about $90 a month.

So yes, taxes would go up, but they would be more than offset by the fact that people would not have to pay for health insurance any longer. In this extremely simplified average, this means that each working person in the United States will see an average of $460 more in their pay each month.

Granted, these are drastically simplified numbers, and this example makes a lot of assumptions, but it is fine for illustrative purposes. The long and short of it is this: single payer will give us better results, at a lower cost, than the ACA, and definitely a better scenario than the ridiculousness put together by the Republicans in Congress.

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