*ACTION ALERT*: REPUBLICANS ARE AGAIN TRYING TO RIP AWAY HEALTHCARE FROM MILLIONS. DON’T LET THEM. CALL YOUR REPS AND YOUR SENATORS (CAPITOL SWITCHBOARD: 202-224-3121) AND TELL THEM TO VOTE AGAINST IT.

VISIT https://www.indivisibleguide.com/resource/trumpcare-another-name-graham-cassidy/ TO LEARN MORE.

The Issue:

Health care is a complex policy area—the array of health plans and types of coverage is mind-boggling. The overall picture is much simpler: the United States spends more and gets less than any other advanced economy in the world for health care. Per the OECD, the United States in 2015 spent 16.4 percent of GDP on health care, a full 5 percent higher than the next highest country (the Netherlands). Despite this, US health indicators lag behind our peers. Out of 35 advanced economies, our life expectancy ranked 27th (78.8 years), our infant mortality rate ranked 32nd (5.8 deaths per 1,000 live births), we are last in obesity (30.1 percent of the adult population, 9 percent higher than the next-highest), and we are last in coverage (11.3 percent of US adults were uncovered in Q1 2017, according to a Gallup poll; the next-highest is Mexico, at 7.1 percent). No matter which way you parse the data, it is clear that health care in the United States is middling at best.

So what causes this? Why do we spend considerably more than any other country for health outcomes which can charitably be described as average? In a word, profit. The concept of insurance is based on risk-pooling; an insurance company will use the monthly fees paid by its users to pay for one of its users’ procedures. The higher the ratio of healthy people to unhealthy people, the more money the insurer will make, because they will have to pay for fewer medical procedures. Therefore, the insurance companies, which are for-profit businesses with shareholders to pay, are incentivized to not insure people who are more likely to get sick: the elderly, those with pre-existing conditions, etc. Given that those individuals are the ones who most need insurance, this is, to put it mildly, problematic. Unlike with, say, candy bars, a consumer in the healthcare market cannot substitute another option or go without if their preferred product becomes too expensive—if a health insurer cancels a plan or dramatically increases premiums of someone who contracted diabetes, and they cannot pay for the premiums or for the insulin out-of-pocket, they are going to die.

Americans’ aversion to big government has long blinded us to the reality that there is one proven solution, and only one, to the healthcare quandary: single-payer health care for every American. Single-payer health care is government-provided health care. The immense risk pool of a single-payer health care system makes it by far the most cost-effective option. In addition, competition from a universal government plan would force down health care costs system-wide. This is not theory—it has been borne out the world over. The verdict is in, and has been for some time: single-payer is the most fiscally responsible health care strategy.

 

The Politics:

Republicans: The Republican position on health care is that only the well-off should have it, and the government should play no role in providing it. Some Republicans are probably aware, somewhere deep down, that single-payer health care is the best option, but to admit that would be to admit that government can be a positive force in everyday life. That is a bridge too far.

To the GOP, if you don’t have a job which provides health care or you are too poor to pay for it on your own, you don’t deserve to be insured. Their latest atrocity, the Graham-Cassidy plan, is arguably the worst of the ACA repeal plans (it is opposed by patients, doctors, hospitals, insurance companies) they have put forward so far, taking $300 billion from state health care over the next ten years, eliminating federal protection for preexisting conditions, would cause a 20% increase in premiums next year, and eliminates programs to help low-income people pay for insurance (summary of bill here). In order to pursue this terrible option, Congressional Republicans killed a bipartisan effort to stabilize the ACA insurance markets, which would have provided more insurance for lower prices nationwide.

It cannot be emphasized too much or too often: Supporters of this bill do not care about you or about making lives better. They are unfit to govern and need to be removed from public service.

Democrats: A healthy majority of Democrats want a universal, government-provided health care option. Given where we were as a country on healthcare ten years ago, this is a stunning shift. The party is divided over how to achieve this goal. Centrist Democrats want a more cautious, incrementalist approach—working through the ACA to expand Medicaid, bringing down prescription drug costs, creating a public option through the ACA—while the left wing of the party is pushing for Bernie Sanders’ “Medicare-for-all” legislation, which if passed would extend coverage to every American. Both of these approaches have merit—the timing of Medicare-for-all proposal is an acknowledgement of the fact that for the first time ever, the idea of universal government-provided health care is popular (according to a June Pew Research poll, 60 percent of Americans believe it is the government’s job to provide health care, while 33 percent believe that a national single-payer system is the right model, up from 21 percent in 2014). The proposal will not pass, but it builds on the reframing of the healthcare landscape which the ACA began. This is important, because it makes the incremental approach, which I believe is ultimately how we will achieve universal healthcare, look more moderate and leaves room for compromise.

The choice is clear. Democrats are fighting to expand healthcare access to all Americans. Republicans are fighting to reduce the number of Americans with healthcare and make existing plans more expensive. Which would you prefer?

Andrew Orlebeke
After working in Washington, D.C., for two years, Andrew Orlebeke ('10) is in graduate school in Seattle, Washington, studying public policy. In addition to public service, he has a passion for traveling and an abiding love of sports.

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