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The GOP's failed health plan shows Americans have changed how they think about health care

The GOP's failed health plan shows Americans have changed how they think about health care

Picture of Trudy  Lieberman
[Photo by Chip Somodevilla/Getty Images]
[Photo by Chip Somodevilla/Getty Images]

The defeat of the Republican’s American Health Care Act and the troubles the GOP has had ever since cobbling together a repeal-and-replace alternative signal a pivotal moment in U.S. health care. The Republicans’ laissez-faire vision moved the needle on Americans’ thinking about health care. They are beginning to realize that our “uniquely American” system” doesn’t cut it anymore.

The historic defeat three weeks ago warned politicians that everyone needs health coverage, benefits must be comprehensive, and sick people can’t be left out.

Each time Republicans tried to mess with one of those elements, others in their caucus said no dice. Their constituents and newspaper editorial writers back home had spoken. The St. Louis Post-Dispatch editorialized, “There are so many things wrong with this plan that it’s hard to know where to begin.” The Virginian-Pilot called it “a non-starter, from both policy and political perspectives.”

The American way of health care has always left a portion of the population without coverage and, in many cases, without care. The number of uninsured has fluctuated over the years, but Obamacare brought down that number to its lowest point in history. Republicans wanted to turn back the clock, taking away coverage and adding another 24 million people to the ranks of the uninsured, according to the Congressional Budget Office. That was unacceptable.

Even in Kansas, one of the 19 states refusing to expand Medicaid, an effort last month to override Gov. Sam Brownback’s veto of an expansion bill this year failed by only three votes. Supporters, both Democrats and Republicans, say they will keep at it until expansion passes. “Medicaid expansion is a path out of poverty helping low-income Kansans pay health costs and reduce debts,” pleaded state Rep. Susan Concannon, a Republican, who tried to corral the votes to override. “Your communities, your people, want this.”

When it came to Republican attempts to pare down Obamacare’s “essential benefits” package that includes maternity care, mental health treatment, and prescription drug coverage — benefits often omitted from individual market insurance policies in the pre-Obamacare days — the question became: Which ones were expendable? There was no GOP consensus and no deal. They were all important. When the Freedom Caucus insisted on adding a provision to the bill that would make it tougher for sick people to get insurance, it was a non-starter.

There’s even a flicker of recognition among voters that something must be done about that Achilles heel of the U.S. health care system — rising costs with few meaningful brakes to control that growth. After the GOP’s retreat, Vox sat down with a Trump voter named Sherri Underwood who said she was skeptical Democrats and Republicans could work together to hammer out decent legislation partly because of special interests running the show. “If they don’t work together to get at the crux of the issue of rising health care costs, I’m not sure that any plan they put forth will be ideal,” the voter said.

The GOP’s overreach brought more press stories about single payer, or national health insurance, as I prefer to call it, than I’ve seen since Obamacare was debated eight years ago. Voters are not afraid now to say they like the idea. Last week, Vox’s Sarah Kliff wrote that during a recent focus group with Trump supporters who were also Obamacare enrollees, the moderator asked the group: “Who likes Canada’s health insurance system? Who wishes we had something like that?” Half the people in the six-member group raised their hands. “I actually like socialized medicine,” said one group member. “There’s a lot of countries that it works very successfully in,” said another.

TV commentators raised questions about why 60-year-olds need to have plans that cover maternity care. They never mentioned that someone pays when the 60-year-old someday needs complicated eye surgery. No other country I know of talks about health care in such narrow, self-interested terms.

Perhaps even more significant was David Leonhardt’s New York Times column, “Republicans for Single-Payer Health Care.” Leonhardt noted that private markets don’t work well for health care and argued that government programs like Medicare are hugely popular and others like Medicaid work well. When Democrats are next in charge, “they should expand government health care,” Leonhardt wrote. “They should push the United States closer to single-payer health insurance. ”

The pushback against the American Health Care Act has softened the ground for that approach. As I noted in my last post for this site, Rep. Jason Chaffetz also helped with his outrageous comments suggesting that if people want health care, they should give up their cell phones to pay for it.

Along with this new surge of interest in a single-payer approach must come a new way of thinking about what health care should be. Many of the news stories reporting on the failure of the GOP’s plan centered on the challenge of getting healthy people into the insurance risk pool, making private insurance attractive to them by paring down benefits and offering spartan coverage, making coverage cheap enough, and boosting insurers’ bottom lines. TV commentators raised questions about why 60-year-olds need to have plans that cover maternity care. They never mentioned that someone pays when the 60-year-old someday needs complicated eye surgery. No other country I know of talks about health care in such narrow, self-interested terms.

We need to think of health insurance as providing guaranteed coverage for life for everyone. With everyone in the risk pool, as is the case with Medicare, it’s possible to cover the very old and the very sick at a reasonable cost because the “younger” beneficiaries don’t need as much care. There’s a cross-subsidization going on. The 60-year-old women who complain about having to buy maternity care will need coverage for eye surgery as they age, and premiums from younger people will help cover those costs. And when a 32-year-old has a complicated delivery, premiums from older workers help finance that care. This shift in our narrative and how we think and talk about health insurance is crucial if American health care is ever to change. “It will take time and involve setbacks,” Leonhardt argued, but those fighting for change “are likely to succeed in the long run.”

Veteran health care journalist Trudy Lieberman is contributing editor of the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care blog.

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