With the apparent inability of the Republican members of Senate to agree upon a replacement bill for Obamacare, Democrats are gleefully celebrating. Chuck Schumer (D-NY) insists that now Republicans and Democrats can sit down together to fix the problems of Obamacare, rather than do away with it entirely. But their idea of fixing Obamacare is to go the way espoused by Senator Bernie Sanders, creating a single payer, government health plan that covers everyone in the country at little or no cost. They suggest that it is barbaric and short-sighted for an enlightened Western civilization not to provide free health care for its citizens.
But what would such a health care system entail? How would it work in a nation of over 325 million people? We can get an idea of what that would be like by looking at the models that currently exist. Canada has universal health care and has for years. As a result, many Canadian doctors have moved to the United States to practice because they could make more money here. The idea of a single payer system is that it would drive health costs down and any senior citizen who has looked at his statement from Medicare can tell you that of the hundreds of dollars that a hospital or doctor might charge for tests, only a small percentage is okayed . . . and paid . . . by Medicare. If the providers accept Medicare, they agree to accept far less money for their work. Given the horrendous costs of medical care in the U.S., this doesn’t seem like a bad idea.
But let’s consider it from the other angle as well. We all know that college tuition has been allowed to grow astronomically, often leaving even a four-year graduate with crushing student loans. Consider the costs of a medical degree. Four years of college, followed by four more years of medical school. According to the Association of American Medical Colleges, in 2013 the median four-year cost of medical school alone ranged from $207,866 to $278,455 and that is on top of the first four years of college. How can someone loaded with the debt of that training afford to work for the pittance paid by Medicare without the addition of private insurance patients to fill in the gap? If everyone had Medicare, doctors would never be able to pay off their debt, never be able to make a decent living. How many of the brightest and the best young people would choose to go into the medical profession under those terms?
But the danger of losing good doctors isn’t the only drawback. In 2013, Canadians on average had to wait four and a half months for medically necessary treatment that had been referred by a general practitioner. As you can suppose, some of them did not live to receive the treatment.
If this sounds familiar, consider the scandal with the Department of Veterans’ Affairs where at least 35 veterans died while waiting for care at the Veterans Affairs hospital in Phoenix, Arizona. Despite the billions of dollars poured into the Veterans health care system, wait times continued to be unacceptable, appointments were sometimes cancelled, and the system protected fraudulent and incompetent employees. Thanks to a bill passed by Congress and signed by President Trump making it easier to fire incompetent VA workers, Veterans’ Affairs Secretary David Shulkin has fired 526 employees, demoted another 27, and temporarily suspended an additional 194 employees for longer than two weeks. Despite the actions of the Trump administration, however, the problem with the Veterans’ hospitals points out the difficulties of a centrally run large health care provider.
Still, the cost of national health care continues to be the biggest problem to the system itself. In France, whose health care system is considered to be the best example, the health care budget is exceeded by billions of euros every year and the head of the association of French pharmacies says that the system cannot survive more that six years without deep reform.
In Italy and Spain, cuts to the health care system are having to be made in order to sustain it. The new director of the Care Quality Commission in the Great Britain (England) that oversees standards recently said that their system is on the brink of collapse.
The California Senate recently passed a universal health care bill that would have cost the state more money to fund than their entire current state budget. Governor Jerry Brown wisely announced he would not the sign the bill should it reach his desk, and the Speaker of the House refused to consider the bill. There was simply no way to pay for it.
The great idea of the left is to tax the wealthy at enormous rates and use that money to give free things like health care to the rest of the country, but there simply aren’t enough rich people in this country to cover those costs. The taxes of the middle class and even the poor will have to be raised considerably in order to fund “free” health care. Let’s look at the example of Great Britain. In 2015-2016, all citizens earning from nothing up to 31,785 pounds sterling ($41,492) had to pay 20% of their entire income in taxes. The 45 percent of Americans who currently pay no income tax at all would suddenly find themselves paying a whopping 20%. Even for someone who earned, say $10,000, $2000 would go to the federal government. And stay there. There would be no “earned income credit,” no “child credits,” nothing to reduce that 20% tax.
Anyone in Great Britain earning even a penny above that base rate has their tax rate jump to 40% up to 150,000 pounds sterling ($195,810). For those earning more than 150,000 pounds, the rate jumps to 45%. Since many small businesses in the U.S. file taxes as individuals, this would tax them at 45% of their revenue, a crippling, unsustainable burden for those who provide the majority of jobs in this country. Also, given this scenario, a teacher in the U.S., earning $41,493 ( Just a dollar over the U.K.’s base salary) would suddenly find himself/herself living on $24,896 while sending $16,597 to the federal government.
How many middle class families are going to accept an effective tax increase of 30-35%? How many of the 45 percent of Americans who now pay no taxes, for whatever reason, are going to be willing to accept a 20% federal tax to pay for health care? It is hardly likely that many of them, struggling to provide food, clothing and shelter for their families, are going to cheerfully choose health care over food and rent!
And that, of course, is not the final problem with government provided health care. The best and the brightest often do become doctors under this kind of system, but they opt out of the government health care system and go into private practice. There will no doubt, unless they are shut down by law, continue to be insurance companies willing to sell private plans to those who can afford them. And if insurance companies are forced out of the health care business, those who are wealthy enough will still be able to get the best health care possible by simply paying for it themselves.
The government plan, in order to survive, will be forced to make financial, rather than medical decisions. They will refuse to pay for experimental treatments which might save lives and limit the care that is provided to the elderly and the infirm. Is the cost of knee replacement surgery cost-effective for an octogenarian whose useful life could be argued to be pretty much over? Cheaper just to treat the pain and leave him/her wheel chair bound. Is it cost-effective to pay for an operation for a sick child if the chances of that operation being successful are only 50/50? 60/40? What becomes the financially acceptable chance of cure before a procedure should be okayed? And finally, who makes that decision? Won’t it become, as in the case of Baby Gard in the United Kingdom, the government and the courts who decide rather than the family?
We are a country founded upon freedom. The freedom of speech. The freedom to practice the religion of our choice or to practice none at all. The freedom to bear arms. The freedom to travel where we wish and to live where we choose. But with Obamacare, we lost the freedom to choose health care or no health care. We lost the freedom to choose the insurance plan or company that best fit our needs. We lost the choice of which doctor we would see or which hospital we would go to. Men and women well past menopause have to pay for plans that cover birth control pills and pregnancy care, despite the fact that they have no need for such coverage. Monthly premiums for those who are not poor enough to get government subsidies jumped to often double what those individuals paid for health care before the Affordable Care Act and have continued to rise year after year. Deductibles are so high that barring a catastrophic illness, most families never reach their deductible. The result is that Democrats can crow about all the millions of people who have insurance under Obamacare, but the reality is that countless numbers of those “insured” people never visit a doctor because their insurance won’t pay for the visits and they can’t afford to pay for them themselves.
I have reluctantly come to agree that perhaps the best option at this point is to repeal Obamacare with a sunset clause of two years as the Senate is now considering. The law would continue in effect for those two years, and people would continue as they are now, paying astronomical premiums with huge deductibles and losing bit by bit their choice of insurance companies as the major companies continue to pull out of the exchanges. Why do I believe that to be the best choice now? Because the Democrats put into play a system that offers free, or nearly free health care to countless numbers of low-income families who do not want to lose that coverage. Some way must be found to take care of those individuals without continuing the impossible costs to the rest of the citizens who have to pay for their insurance. That is not an easy fix, especially not while Democrats are on television telling us how many individuals will die with no health care under the Republican plans or how many senior citizens will lose Medicare or no longer have Medicare pay for nursing home care. Their terror tactics have made it virtually impossible for Republicans to agree upon a single plan. In addition, because of the Senate rules, only a portion of a new health care plan can be put into effect with only a simple majority vote. To correct all the other problems that Republicans want to correct – allowing purchase of insurance across state lines, putting restrictions on frivolous malpractice suits, lowering prescription costs — these can not be passed without some Democratic votes, and until Obamacare has been repealed, no Democrat will vote for anything that might replace it. Consequently, the bills the House passed and the Senate has tried to bring to a vote are incomplete and flawed. They would provide only a partial fix for health care and some senators can not bring themselves to vote for such a flawed bill, trusting that other changes and additions will be made later.
Democrats would love to work to “fix” Obamacare, but it is such a flawed system that bandages will not hold it together for long. A repeal now, with a two-year sunset clause, will force Democrats to the table with Republicans and allow enough time for this immense problem to be resolved in a manner that gives Americans back their freedom to choose. To choose their own doctors. To choose their own insurance coverage just as they can choose their own car insurance or their own homeowners’ or renters’ insurance. The free market works with those insurance plans. It would work with health insurance as well. Congress needs to repeal Obamacare now and work for the next two years to find a real solution, a free market solution, not a cobbled up patchwork, and certainly not a single payer, government-run plan that will work no better than the Department of Veterans’ Affairs has worked.