Why Americans Remain Sick!

Of all of the current Trump proposals, the American people should be more concerned over the initial plans for health care reform than anything that has happened so far. Normally, health reform relies on several participants including: hospitals, physicians, pharmaceutical companies, insurance companies, and patients.  Health care works best when the consumer has the ability to pay for these services or the system pays the patient's bills.  Most nations with universal health care have a single payer system where every citizen is covered by the same insurance and has equal coverage.  The physicians, pharmaceutical companies, hospitals and insurance companies know exactly how much to charge and how much they will make.    In terms of health care, the United States ranks low when compared to other developed nations. American businesses runs health care and they have always feared that universal health care would collapse the profitability of the medical and insurance professions. Progressives realizing that the sick endangered all classes demanded health care reform at the beginning of the 20th century and then again during the Great Depression.  To counter reforms that they feared, the medical professions responded by labeling "universal health care" as "socialism".  Thus the movement to reform health care languished for over 100 years. The Democrats became the proponents of universal health care and the Republicans rallied against it by calling it another social welfare entitlement. In such a heated environment, it is easy to see that corporate and governmental compromises would probably create flawed health care plans which would produce socio-economic challenges in the years to come.  Such difficulties were unavoidable. Due to the necessary compromises in the legislative process, the Affordable Care Act was passed with multiple flaws.  Foremost, it pushed for everyone to be insured, but an individual's coverage is not uniform.   Because the legislation mandated that larger employers provide group coverage to full-time employees these people may have very different plans than persons who are self-employed or are part-time workers who have to negotiate single coverage with to insurance companies or cooperatives.  As a result, the amounts that could be charged and the amount that could be covered by plans are not fully regulated.  And with this type of universal governmental health care, the role of the federal government is to work with state governments to help subsidize the ability to pay so that everyone has equal access to good care.   The ACA or “Obama Care” was based on the principal that everyone American would have health care and to guarantee that everyone had health care it forced every American to sign up for coverage and it taxed wealthy Americans to subsidize the less fortunate.  Additionally, the states worked with and independently of the federal government to ensure that the poor and working classes were covered.  In some states this meant expanding Medicaid benefits to the address gaps in insurance coverage. Obama Care’s success or failure largely depends on the pharmaceutical companies, doctors and hospitals charging high prices and receiving better than 80% reimbursement.  It also means that the insurance companies need to make profits from selling insurance.  The deal that made the ACA work was the promise that these parties would remain satisfied.  Sadly, in less than five years, the insurance companies are not happy with their profit margin. In response they raised premiums to ensure profitability, and this action threatens the ACA. In response, Republicans suggested that the ACA is in a death spiral and it needs to be replaced.  With the support of candidate Trump, Republicans called for the repeal and replacement of the ACA.  However, the newly proposed Republican health care plan, "The American Health Care Act" or what is being labeled as “Trump Care”, is being rolled out with more flaws than “Obama Care.”  In contrast to what candidate Trump promised as “coverage for all,” this will be “access for all.”  Trump Care is not universal health care but a route to securing health coverage.  All signs point to this plan costing more and passing additional costs onto the states.  With the removal of the tax on the wealthy, this plan lacks financial subsidies.  And without penalties, those who do not want insurance will not be forced to purchase it.  Most of the key partners needed for this venture’s success are already denouncing the plan.  The American Medical Association, the American Hospital Association, and several nursing organizations have already expressed their fears that the Republican plan will raise premiums for most Americans and that insurance companies will not want to cover patient costs. Advocate organizations including the AARP, the American Heart Association, the March of Dimes, and the JDRF Diabetes Foundation have also denounced the plan.  And insurance companies, the most pivotal partner in the process, are not agreeing to cross state lines to insure patients.  They realize such actions will not be profitable. The Republican plan is less financially stable than the ACA. Hence, for all intensive purposes, “Trump Care” is Dead On Arrival. It may pass the House, but without modifications it will die in the Senate. Yet Trump is pushing the plan forward as if he is fulfilling a campaign promise, despite the fact that those who voted for him wanted more than a replacement plan, they demanded a better plan!  Sadly this is not going to happen. Trump cannot balance his plan to cut taxes for the wealthy and provide quality care to all at the same time. Recently David Leonhardt of the New York Times wrote: Many Americans over the age of 60 would have to pay more for health insurance under the Republican health care plan. Many low-income families would lose their insurance. Many disabled people, hepatitis patients and opioid addicts, among others, would no longer receive treatments that they do now.

Leonhardt continued by arguing that the “billions of dollars in savings from these cuts would go to those earning at least $700,000 a year, according to the Tax Policy Center. A disproportionate amount of the savings would go to the richest of the rich — those earning in the millions.  In other words the health care bill is “a tax cut for the wealthy.” Charles Blow, another Times columnist, has also criticized the Trump/Republican health care plan.  He wrote: “the plan just announced and endorsed by Trump doesn’t even come close to delivering on this promise. Not only would prices most likely rise for many Trump voters, but millions of Americans would be at risk of losing coverage under the plan.” What Blow and others are quick to highlight is that those who were the symbols of the campaign – the forgotten Midwesterners who don’t have jobs, have children strung out on drugs and unable to send them to college – will most likely not be able to gain coverage in this new plan. Those people who need the additional resources from Medicaid will not get them as their cash starved states will not be able to fund the differences between the federal cuts and their budgets. But if Trump was being honest, his whole health care agenda would have to change. He would wait for a report from the Congressional Budget Office to provide statistical data before moving forward on this proposal.  Yet the Republicans are rushing the plan forward through committees without the critical financial information. Trump Care does not address the key issue of the rising cost of health care and the inability of most Americans to pay for quality care.  It does not address the corporatization of hospitals, the merging of regional hospitals into singular corporations, the demise of public hospitals, and rising malpractice costs.  This plan does not protect the health care workers who spend years in higher education and graduate with large loans which can only be paid if they receive high salaries. Trump Care does not address that most American salaries are not increasing fast enough to address the rising costs of higher education, housing or medical care from prescriptions to hospitalization.  The problem is bigger than President Trump is willing to admit. Trump Care is like putting a band-aid on an elephant! The President needs to be honest with his core base that gave him his presidency. He would have to address why and how drug manufacturers and the insurance companies will benefit from the proposed health care plan. He would have to share the facts that numerous health care corporate executives will get tax cuts that are so large that they will seem like bonuses.  That he wants to remove regulations on the pharmaceutical industry so that they can release new drugs into the market with less safeguards so that profits can rise even if some people die. Eventually, the president would have to inform Americans that he lied and he is cutting the Medicaid expansions, and probably to a large extent gutting Medicaid and Medicare. The facts show that older Americans would pay more, even up to three times more for insurance at a point in their lives when most are living on fixed incomes.  And, contrary to what is being stated by the President or the Speaker of the House,  those who are slated to lose the most are children and the poor.  That coverage will be limited and capped for certain groups. Or that the Midwesterners that President Trump believes are strung out on drugs are more likely addicted to pharmaceutical pain pills than illegal drugs from Mexico.  That the pharmaceutical industry is operating unchecked in American society and it is partly responsible for the rise of medical costs.  That the desire to de-fund Planned Parenthood, which is tied to the new Republican plan (pages 3-4), has nothing to do with abortions as no American hospital or clinic is reimbursed for abortions. And the sections of the bill (pages 10-16) that focus on lottery winners are based on a single story reported on Fox News. Ultimately, it is important for the American people to realize the truth.  In less than two months, President Trump has learned it does not serve his best interests to be the president of all.  The base that loved candidate Trump is slowly being discarded. Now that he is president, the only thing that they can do for him is support his re-election. But why should they?  He has decided to cast his lot with the top one percent.  The same people who have historically not accepted Trump as one of their own are now calling the shots. They are in his cabinet and they are the architects and beneficiaries of his proposals and schemes.   So, at the end of 2020 will the average American be able to say he or she is healthier now than they were in 2017?