Three ObamaCare replace myths
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Conservatives believe in truth—embracing myths in public policy can be disastrous. Three myths about replacing ObamaCare must be dispelled or replacement will fail. The first myth is that replacing ObamaCare creates a “new” entitlement to universal healthcare or health insurance that did not previously exist.  The second myth—cutting funding for coverage means that society saves money. The third—Republican politics demand a paltry replacement or none at all.

Congress has entitled Americans to healthcare whether or not admitted. I know this from years working in a hospital for the uninsured, watching as asthmatics, diabetics, heart failure patients, drug overdoses and schizophrenics came as long as doors were open. Congress created the Medicare, Medicaid, VA, Tricare, Indian Health Services and Ryan White entitlement programs to pay for coverage and treatment. The tax code subsidizes the purchase of employer based insurance to the tune of about $3.6 trillion over 10 years. The Emergency Medical Treatment and Labor Act (EMTALA) says that the uninsured can go to any emergency room to be seen, treated and admitted to the hospital if need be. Congress has already created an entitlement to universal healthcare.

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The second myth is that cutting federal support for coverage saves society money. The Disproportionate Share Hospital program (abbreviated DSH and also called “uncompensated care payments”) partly pays for the uninsured. Aside from the DSH program, society pays the rest of the bill for the uninsured when hospitals shift the remaining cost to the privately insured (typically employers and their employees) who pay higher premiums to underwrite the “free care” the uninsured receive. If a patient needs social support—independent of the cost of healthcare—this is an additional expense.

As an example, everyone reading this knows someone or was personally diagnosed with diabetes. A doctor can treat diabetes so that the impact to health is marginal. But someone making $16,000 a year who, does not qualify for Medicaid, cannot afford the employee’s share of employer provided insurance and cannot pay cash for doctor visits or their medicines is not treated. Their blood sugar is always too high and they regularly go to the ER when their blood sugar becomes drastically uncontrolled. Each hospitalization costs society tens of thousands of dollars.

As this cycle of ER visits and hospitalization continues, the patient suffers stroke, heart failure or kidney failure. Then, instead of working and paying FICA and other taxes, they are disabled, receiving Social Security disability with taxpayers paying for their expensive healthcare through Medicare and Medicaid. An ObamaCare replacement which restricts coverage without access to first dollar coverage for treating diabetes, opioid addiction, mental illness and other chronic conditions puts the cost burden on ERs. This does not contribute to life and the pursuit of happiness. It is better to give patients adequate coverage. Ultimately, society pays.

The third myth is that it is good politics to not replace or to have a meager replacement of ObamaCare. Those who supported Trump for President have the most to lose under some proposed plans. In the red states which expanded Medicaid, Trump won the majority of those enrolled in the expansion. Vox interviewed Trump voters in southern Kentucky. They want more coverage not less and believed Trump during the campaign when he said that he was going to give more coverage. Less well-off Americans elected Trump. They are who are losing their coverage. This is bad politics.

It was once said that everyone is entitled to their own opinions but not their own facts. The fact is that it is better to pay for the care that someone is going to receive no matter what, so as to maximize an American’s potential to contribute to society, than to instead pay for expensive, inefficient, episodic care which watches a patient decline and burdens families and society. We should maximize potential. It is good policy. It is good politics.


The views expressed by this author are their own and are not the views of The Hill.