Vail Daily column: The politics of health insurance
March 31, 2017
The future of our health insurance system was recently under intense review by the new administration and the U.S. Congress. Even a Republican majority in Congress and a Republican president were not able to agree on new legislation to replace Obamacare. One major explanation for this difficulty is that there is not general agreement by Republicans on major questions regarding health policy: should every American have health insurance? And, if so, who should pay for it?
There is agreement that every American should at least have access to health insurance. The position of the majority of Republicans in Congress is that every American should be able to choose to buy insurance or not, without a mandate from the federal government that they buy it. As a result of Americans' growing realization that health insurance is a good thing to have, a majority of Congressional Republicans now believe the federal government should provide some level of subsidy to Americans who want to buy but cannot afford health insurance (though the most conservative Republicans in the Freedom Caucus — a small but powerful minority — do not agree with providing subsidies). The great majority of Congressional Democrats believe every American should have health insurance (not just access to it), and the federal government should provide subsidies to Americans who cannot afford the insurance. Democrats want to provide significantly greater levels of subsidies to a greater number of Americans than Republicans, and fund it with the existing tax on the wealthiest of Americans established under Obamacare.
The failure of the Republicans to pass the American Health Care Act — which would have resulted in millions of Americans losing their insurance or Medicaid coverage — is evidence that Obamacare has permanently changed the expectations for health insurance in America.
The 20 million people currently insured under Obamacare — regardless of some problems with the cost of premiums, deductibles and co-pays — do not want to give up their insurance. For the first time in many of their lives they can go see a doctor when ill, and rest assured that if they or a family member gets seriously ill, he or she will receive needed care without placing a ruinous cost onto the family. Congressional Republicans heard this message loud and clear during many of their Town Hall meetings during the past couple of months. And the fact that a major poll found that only 17 percent of Americans supported the Republican bill is also telling. The new fact in American health care is that a large majority of Americans now believe that every American should have health insurance. As a consequence, subsequent negotiations in Congress will need to focus on building support for ways to deliver health insurance to every American — called universal coverage.
A big benefit of universal coverage is the savings generated by uninsured Americans not using emergency rooms as their source of health care. According to the American College of Emergency Physicians, more than half of the emergency room costs are uncompensated due to uninsured patients. Couple this with hospital stays that are uncompensated for similar reasons, and you have at least $100 billion per year of uncompensated costs that have to be paid by hospitals, doctors, and, ultimately, American taxpayers and those of us who buy insurance.
Many of these costs could be avoided: for example, rather than treating an uninsured patient who has pneumonia in the emergency room, imagine the savings if that patient had gone to a primary care physician a month earlier and received much less costly treatment that would have avoided the pneumonia in the first place. This liability of $100 billion should not be society's liability, but, instead be borne by patients requiring the treatment. And under universal coverage, these patients' health insurance would be responsible for the liability. Interestingly, this is exactly how we treat auto liability insurance — every driver must have this, and policies pay for the liabilities resulting from car accidents (which is estimated to amount to over $800 billion each year).
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I am hopeful that, once the dust clears from the recent failure of American Health Care Act, some real leadership will emerge in Congress from both parties, and include the president, that will result in amending Obamacare so that America can join the group of every other well-developed country on earth in making sure all its citizens receive the medical care they need.
Steve Coyer lives in Avon.
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