The US Health Care Conundrum

August 14, 2017 3:50 pm Last Updated: August 14, 2017 3:50 pm

The U.S. Congress has spent the last six months proving a truism: it is far easier to give the population an entitlement than it is to take it away—or even modify it.

Thus, the Affordable Care Act of 2009 or “Obamacare” as derided and pilloried by Republicans, has proved both unpopular and popular. Obamacare was unpopular when instituted as beset by grinding startup problems (as well as the collapse of President Obama’s baseline promises, “If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan.”)

At the beginning of the health care debate in 2006, a study showed 89 percent were satisfied with their health care. And, of the 46 million that didn’t have health insurance, 70 percent said that they received medical treatment and were satisfied with it. To elaborate further, the study showed that 93 percent of those insured who had suffered a serious illness were satisfied with their care as were 95 percent of those with chronic illness. Nevertheless, even with these sanguine responses, 52 percent of those insured believed that losing insurance was a “critical problem” and an additional 36 percent saw it as “serious but not critical.”

Focusing only on those dissatisfied with health care, the study concluded five million Americans were very dissatisfied with their health care; including those dissatisfied in any way raised the figure to 8.4 million.

But there is another adage: “If it ain’t broke; break it.”

And Obamacare was enacted by Congress without a single Republican vote. Permitting them, inter alia to campaign on the “Repeal and Replace” (Obamacare) with the implicit corollary of “Improve” the Obamacare system.

A person walks into the UniVista Insurance company office where people are signing up for health care plans under the Affordable Care Act, also known as Obamacare, in Miami on Dec. 15, 2015. (Joe Raedle/Getty Images)
A person walks into the UniVista Insurance company office where people are signing up for health care plans under the Affordable Care Act, also known as Obamacare, in Miami on Dec. 15, 2015. (Joe Raedle/Getty Images)

But “Repeal and Replace” proved to be a better political campaign slogan than a legislative action plan.  

And for the last six months, we have seen repeated efforts to approve something—anything—that would correlate with the promises made during the presidential campaign.  

Although with great effort, a proposed “American Health Care Act” (AHCA) passed the House of Representatives, it foundered in the Senate. Senators attempted various adjustments until nobody knew what was in any proposed package. A break for Independence Day resulted in many “town meetings” in which concerned/angry citizens inveighed against it.

A late June poll noted that only 17 percent supported the Senate “Better Care Reconciliation Act.” Upon returning to Washington, Senators attempted to pass a “skinny” health care bill, eliminating, for example, the requirement that all pay for insurance or pay a penalty, with sotte voce comment from Republican leaders that it would be further fixed. That also failed.

With this failure, Congress went into summer recess to return after Labor Day.

Republicans remain divided with a majority in a late June poll desiring total repeal of Obamacare. But 46 percent of the overall population wants Obamacare to do more.

Health care has risen to be the most important domestic issue. It has even seeped into comic strips with an Aug. 6 episode of “Doonesbury” quoting a semi-homeless couple declaring “We have a pre-existing addiction!” The addiction? “Insurance” as “We’re hooked! Seven years now!”

It is, however, no joking matter. Insurance denial for a “pre-existing condition” was the most egregious insurance company abuse. One applicant was denied insurance because of a pre-existing condition: acne.

The deadlock, however, forced the Administration to punt, if not throw up their hands in despair. In Republican action planning, savings from remodeled health care was designed to counter revenue losses from revamped federal individual and corporate tax structure. Such also appears in jeopardy.

Republicans appear to have nothing except bad and/or expensive choices. Reaching out to Democrats would involve playing to their tune, e.g., retaining the “individual mandate,” requiring insurance. Allowing Obamacare to “fail” by not providing further federal funding would prompt insurance companies to leave markets (which many have already done) and presumably leave many furious uninsured. Failure to “Repeal and Replace” would violate a core electoral promise and disconcert significant percentages of core Administration supporters—with 2018 mid-term elections impinging on domestic political thinking more every day. And Republicans remember they won the House in 2010 campaigning against Obamacare.

The United States may be carried kicking and screaming into “single payer” (government) health insurance. Historians recall Republican intense resistance to Social Security in 1935 when payment eligibility was 65 and life expectancy less. But after campaigning against it until 1952, when they won control of Presidency/Congress, they found it was too popular to replace. 

David T. Jones is a retired U.S. State Department senior foreign service career officer who has published several hundred books, articles, columns, and reviews on U.S.–Canadian bilateral issues and general foreign policy. During a career that spanned over 30 years, he concentrated on politico-military issues, serving as adviser for two Army chiefs of staff. Among his books is “Alternative North Americas: What Canada and the United States Can Learn from Each Other.”