OPINION: Two Steps Backwards, for American Healthcare

By Richard Gingery

On May 4, the U. S. House Republicans found the necessary votes to “repeal and replace” the Affordable Care Act with the “American Health Care Act.” While their vote does not make the American Health Care Act law, it does bring the act one step closer to becoming law by moving it to the Senate.

In its present form, were it to become law, 14 million Americans who are now insured would be without insurance in the first year and by 2026, 24 million Americans now insured would be without insurance. In the bad old days before the Affordable Care Act, 50 million Americans were uninsured and 45,000 Americans died every year because they lacked insurance. The Affordable Care Act had reduced the number of uninsured to around 28 million Americans, a number still unacceptably high, but the trend was heading in the right direction. Now, should this new “Trumpcare” become law, more than 12,000 newly uninsured Americans will die in the first year. By 2026 there may be a grand total of 52 million Americans uninsured and a death toll in that year that surpasses the pre-ACA death toll.

So what does the Republican House do when it has just condemned thousands of Americans to a premature death? What do they do when they have brought back pre-existing conditions and skewed the system so that premiums rise astronomically for older American workers, putting people at increased risk for bankruptcy and financial ruin? They celebrate! They even send out for beer!

Looking for a historically comparable event, I find myself going back to the Emperor Nero fiddling while Rome burned in the first century. How could a leader be so callous as to turn his back on the suffering of his fellow citizens and play his fiddle? History does report celebrations associated with conquests of “others,” but condemning our own citizens to such a fate should be no cause for celebration.

The Nero fiddling analogy may be apt in another way. Nero looked upon the burning of Rome as a form of urban renewal. He had to burn down Rome to make it “great again.” But in tearing down “Obamacare,” Republicans are not creating anything that will make health care “great again.” They are taking us down a dark road to the past, to a past in which people with pre-existing conditions (and that is a very high percentage of our population) will find insurance inadequate or unaffordable and where the minimal funding offered by this bill to establish “high risk pools” will leave those pools still out of reach of ordinary Americans. We will be taking a step into a past where free market insurance inserts itself once more between doctor and patient. The past will once more swallow us up by underfunding Medicaid both throwing many Americans off of Medicaid coverage and shrinking the pool of physicians who will see Medicaid patients. Hospitals here in Colorado which have large numbers of Medicaid patients will find it increasingly difficult to keep the doors open.

The Affordable Care Act was not perfect, but it was a step in the right direction. Sadly, the American Health Care Act is two steps backward at a time when most Americans recognize that a much better solution is out there for our health care woes. We already have the foundation in our health care program for us old folks. The time has come to lower the age of eligibility for Medicare to zero. Then we can all fiddle, not while the U.S. burns, but because we will have put out the health care fire that has nearly consumed us.

Richard Gingery, MD is a retired physician who has served in two public health departments around the state with a three-decade-long private general practice sandwiched in between. He is a past president of Health Care for All Colorado, an organization advocating for single payer health care.

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