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GOP's effort to roll back healthcare reforms is bad policy

Obamacare isn't perfect, but it's the first meaningful change in the medical system in decades. But Republicans want to reverse its advances and slash Medicaid.

March 14, 2013|David Lazarus
  • President Obama's healthcare reform law is the first meaningful change to our monumentally ill-conceived medical system in decades.
President Obama's healthcare reform law is the first meaningful… (Ted S. Warren, AP )

Bernie Morse, 65, of Century City retired last year from the aerospace industry and joined the ranks of Medicare beneficiaries. The nearly $8,000 he used to spend annually on drugs for a liver condition now will be cut almost in half.

Were a private insurer to take over his Medicare coverage, Morse believes, his drug bill would once again skyrocket — only he wouldn't have his aerospace income to pay the tab.

"I'd be really scared about what could happen," he said.

And he has reason to be afraid.

Republican lawmakers, in their budget proposal released this week, showed they're determined to roll back President Obama's healthcare reforms, deny coverage to millions, limit treatment of the poor and essentially hand Medicare over to private insurers.

This isn't just bad public policy. It's the perpetuation of a Darwinian struggle between those who have access to affordable healthcare and those who do not.

"There are goods and services that the private market does a very good job of providing," said Mindy Marks, an associate professor of economics at UC Riverside. "Healthcare isn't one of them."

Obamacare isn't perfect. It doesn't extend health insurance to everyone. It doesn't do enough to reduce medical costs.

But there's no getting around this fact: President Obama's healthcare reform law is the first meaningful change to our monumentally ill-conceived medical system in decades.

A quick refresher. Obamacare has:

• Created a system to extend coverage to about 30 million of the roughly 50 million people in this country now without insurance.

• Provided coverage to about 2.5 million young people who are able to remain on their parents' insurance policies until age 26.

• Laid the groundwork for preventing insurers from denying coverage to people with preexisting medical conditions or from canceling people's policies after they get sick.

• Set in motion an overhaul of insurance reimbursements to reward doctors for keeping people healthy rather than profiting only when people require costly tests or hospitalization.

Not only would the Republican budget plan take away all these advances, but it would also drastically cut spending for Medicaid, the insurance program for low-income people. The Urban Institute estimated last year that the GOP's approach could reduce Medicaid enrollment by half.

"More people without insurance is a move in the wrong direction," said Martin Gaynor, a professor of economics and health policy at Carnegie Mellon University.

There are also concerns about the Republican plan to turn Medicare into a voucher system. Although it might sound good for seniors to be able to shop around for coverage, the reality is that vouchers would create an incentive for private insurers to cherry pick healthier people by offering them cheaper insurance.

Sicker people would have no choice but to remain with the government-run insurance program, which would see its costs soar because of the greater risk posed by remaining beneficiaries. Those beneficiaries, in turn, might have to pay more out of pocket because their vouchers wouldn't cover rising premiums.

You can't fault private insurers or hospitals for trying to maximize profits. They're businesses, after all.

But we're not talking about widgets here. We're talking about people like Bernie Morse, whose lives depend on access to affordable treatment. The profit motive simply shouldn't be a factor.

If Republican lawmakers are so concerned about saving money, they should take the lead in ending the ludicrous system of tying most people's health insurance to their work.

The Great Recession cost about 8 million Americans their jobs. That's millions of individuals and families who lost health coverage through no fault of their own. The United States is one of the few countries that provides health insurance in this way.

Nearly all other developed nations — our economic peers, as it were — have some variation of a national insurance plan to guarantee affordable healthcare to all. And most of these nations spend about half as much per person on healthcare as the U.S. does.

"We still have to decide whether healthcare is a privilege or a right," said Tony Sinay, a healthcare economist at Cal State Long Beach. "If you look at other countries, it's a right."

Republican lawmakers should think about expanding the Medicare system, not shrinking it. Or do they think it's just a quirk of being French or British or Swedish that allows these people to spend less on healthcare but to enjoy longer life spans than average Americans?

Laurence Baker, a professor of health research and policy at Stanford University, said a Medicare-for-all system could solve many of America's healthcare woes, particularly if it could be structured to contain costs while extending coverage to all.

"The problem is that trying to take apart our existing system would be really hard," he said. "A lot of countries that were able to do it did so in the 1940s and 1960s. Because we've waited so long, it makes things that much harder."

To which the obvious reply is that we're Americans. We pride ourselves on not shying away from challenges just because they're tough.

Or at least we used to.


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