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Steve Nelson: With Health Care, Someone Has to Pay

The Fresno Bee - SW Parra

The Fresno Bee - SW Parra

Someone has to pay. This simple statement is at the heart of the endless politicking over health care reform. It is elephant in the room with whom neither party will dance.

The failure of the New Hampshire Senate to affirm a Medicaid expansion deal at a special session on Thursday is a case in point. Democrats want to take advantage of the Affordable Care Act’s full three-year funding of health coverage for adults living near poverty. The federal funding drops to 90 percent by 2020, and Republicans fear that the state will be stuck with the rest of the bill. The stalemate seems irreconcilable. Neither party wins, but 50,000 eligible New Hampshire residents lose, because someone has to pay, and in this case it’s they who will pay the price of inaction.

Reasonable people acknowledge that something had to be done. For 45 million uninsured Americans, there were only three possible outcomes in the event of illness. They might delay treatment, leading to needless suffering and the likelihood of more expensive later care. They could seek treatment, incurring crippling debt or bankruptcy. Or they could receive emergency care at much higher cost from a facility that would factor this expense into overall fiscal planning. Someone had to pay.

This entire health care crisis started because someone didn’t want to pay. “Someone” is corporate America, aided and abetted by Congress and by the bamboozled working-class folks who have been conned into voting against their own interests. In the name of rugged individualism, self-reliance and free-market competition, multinationals have gutted benefit programs, shipped jobs to nations where poverty-level wages are an improvement, and abandoned America’s workers to fend for themselves, especially for their own health care.

So along comes the Affordable Care Act, which has nearly instantly been transformed from the president’s greatest triumph into an albatross around his neck. The ACA was destined to fail, or at least to lurch ineffectively forward.

The gleeful scorn now expressed by the GOP is partly because of the admittedly lousy “roll-out” of the program and flawed website. That gaffe was an early holiday present. Then Republicans were given the bonus gift of the president’s alleged “lie,” which was his misstatement that no one would be forced to drop an insurance plan they wanted to keep under ACA. The president indeed misspoke, but while the criticism he has received is politically potent, it is factually trivial.

As reported by MIT economist Jonathan Gruber, the facts are these. About 80 percent of Americans’ coverage will be unaffected by the ACA. About 14 percent of Americans were previously uninsured and will now be covered because of health reform. Of the remaining 6 percent, half are people who were covered before and will be required to buy a new plan, but at no significant change in cost. That leaves 3 percent, who were covered before and will have to pay more for a plan. But even those 3 percent pay more only because they will be forced out of substandard, high-deductible plans, which could cost them up to $6,000 yearly in out-of-pocket expenses. Their premiums go up, but their well-being and security will be materially improved.

So much for Obama’s big “lie.” But the bigger lie is that there is a free lunch. Health care is like a banquet table at which lots of folks dine and no one wants to pick up the check. Corporate executives and members of Congress left the restaurant and dine together at a private club. The rest of us are left at the table to argue bitterly over the unpaid bill they left behind.

The ACA is so arcane and riddled with loopholes that it will either fail completely or only modestly improve the overall well-being of our citizens. Because we tried to create universal coverage within private markets, the insurance industry is playing whack-a-mole, just as one might expect. If a regulation forces rates down in one realm, they will rise in another. The entire system is based on an intentionally obscure redistribution of the real costs. The subsidies available for the elderly, or those mired in poverty, only work if substantial numbers of healthy young people enroll in the program. That is a very big “if,” and this risky strategy may have sunk the program even if it had not been poorly initiated.

The New Hampshire situation is replicated all around the country. While I think the stalemate is ridiculous, and rejecting health care for 58,000 poor citizens is bad policy, it is a result of the deeply flawed ACA. Someone has to pay. The current system is a ham-handed attempt to redistribute wealth in America without saying it.

It needn’t be so complicated. A modest recalibration of our regressive tax structure could provide universal health care at a cost proportional to each person’s ability to pay. The only solution to health care in America is a single-payer system with complete transparency and a progressive form of funding. Conservatives call this socialism. I call it civilization. I’m not holding my breath. The only sacred entitlement in America is profit.

Steve Nelson lives in Sharon and New York City, where he is the head of the Calhoun School, a private school.

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