It took me a while to write this post today, I had to calm down after finally reaching the boiling point from reading all the nonsense being spouted about attempts to change the current federal health insurance law. When the Affordable Care Act was passed, few people understood how far-reaching this law was, how many esoteric provisions it contained. The primary focus was on the coverage provisions and we were told as an article of faith that the law would ensure coverage for everyone and would do so at a lower cost. That was simply bullshit and the people who proposed and supported the ACA knew it, which makes them liars. Because the law touched so many aspects of health care, it actually has some very beneficial provisions, which are probably underappreciated. But its discombobulation of insurance markets was actually all too predictable and because more coverage was highlighted as the raison d’etre of the ACA, its failure to achieve that end gets all the attention now. But as usual our genius legislators ignored the warnings. So now we have a useless individual insurance market and premiums in the group market haven’t slowed at all. Taxpayers are on the hook for tens of billions more in health spending for subsidies and the Medicaid expansion.
And now the new Administration and Congress dare to suggest that we should perhaps change the law; maybe attempt to ameliorate the damage it has done. Why, how could we think of such of thing, people will lose coverage, they will die, providers are alarmed, patients are worried!! The people will die meme is the most outrageous–according to Nancy Pelosi, clearly in need of Alzheimer’s treatment, it is hundreds of thousands, if not millions of people. But lets take even the 24,000 more deaths that supposedly solid research says will occur from changing the law. There in fact is no credible research that clearly demonstrates that people who don’t have insurance die sooner than they otherwise would. Timing is obviously the issue, since we all are going to die at some point. This research uses the same approach to manipulating data, bad trial design and bad statistics as another paragon of scientific research, climate change. And the results are just as credible.
Another obvious flaw is the notion that all these people will lose Medicaid coverage if federal funding is cut. Medicaid was supposed to be primarily paid for by the states. As far as I know, every taxpayer is either an individual who lives in some state or is a business domiciled in a state. I am not aware of a law that precludes states from expanding Medicaid as much as they want and taxing people and businesses to do that. And since reducing federal spending on Medicaid should mean less federal taxes for that purpose, there is an equal opportunity for the states to pick up that tax burden. Medicaid should never have been and doesn’t need to be a federal program. It should be handled at the state or even local level, and decisions about eligibility and how much a populace is willing to spend should be made at that level.
Of course, the most disturbing thing is the complete absence from the conversation of the disastrous debt burden our country bears and adds to every year. We have to wake up and recognize that we can’t keep spending this much money. We are making tax slaves out of our young workers so that they can provide free housing, food, medical car, transportation, phones, and on and on, for a few people who truly need the help and tens of millions who don’t and are just happy to be leeches. Is it any wonder that more and more people want to be the remora and not the shark? It is tragic that those who try to get an education and a good job to have a liveable income have to see so much of that income taken to support the leeches; causing them to delay decisions about marriage, children, buying a house and other things that make life more fulfilling. We are in bad shape and health spending is a big part of it. The real danger is that we don’t take truly dramatic action to lessen the burden we are placing on our citizens and our economy.
Quick update–in my haste for the holiday weekend, I left out my favorite comment, from the esteemed Doctor Rand Paul, Senator from Kentucky, who said that health insurance should cost a dollar a day!! Uh, yeah, Doc, maybe if opthamologic surgeons didn’t have to have to make $500,000 a year or more and hospital administrators didn’t multi-million dollar compensation packages, that might be possible in some other part of our multiverse. Wealthy physicians probably should say anything about fixing the health care system.