American healthcare isn’t exactly on the mend

The Affordable Care Act is stuck in a unique sort of purgatory at the moment. It’s fitting, really, given its tumultuous life that after rushing to sentence the bill to death, constituents of Congressional critics are now asking for a stay of execution.

“Obamacare” hasn’t been without its issues. Premiums for many popular ACA plans spiked this year and a state-run marketplace has its drawbacks. Some wounds were self-inflicted, such as rising costs that plagued the 22 states that opted not to expand Medicaid through the ACA. In spite of its shortcomings, the law still managed to help a significant portion of the individuals it set out to help.

The numbers vary (don’t they always?), but the figure that seems to split the difference from left-and-right-leaning data miners comes out somewhere near 16 million.

One can debate the merits of “Obamacare” all he or she would like, but at the end of the day it helped roughly five percent of the population find coverage. Insurance was (and is) complicated and all parties involved have their own idea of how the system should operate. Prior to reform efforts from Mr. Obama and company, providers ganged up on a vulnerable marketplace. The system was broken. Average healthcare costs in America were more than three times of those in the average OECD country. It was out of control, and the ACA took steps to address that, though results have been mixed; depending on one’s income and state of residence, some benefited greatly while others, sometimes those seeking insurance for small, struggling businesses, saw increased costs (though it must be pointed out, my family’s small company benefited from the implementation of the ACA). But the distinction must be made; there is a clear difference between not being able to afford healthcare (the primary issue with the old system) and spending more than one should for healthcare (the lion’s share of the complaints with the ACA).

Now, Republicans that have had the better part of a decade to draft an “Obamacare” replacement (Trumpcare? Ryancare? GOPcare?)have proposed plans that would walk back coverage for millions of Americans whom Trump promised could keep their plans (in fact, older individuals – a demographic largely responsible for his win, would be most adversely affected), provide billions of dollars in tax cuts to the wealthy, and end coverage necessary to addiction treatment (a stipulation that hits close to home here in Cincinnati). Some aspects even do the same thing they’re supposed to replace, such as Paul Ryan’s own individual mandate-penalty. Not surprisingly, the pushback has been pretty tremendous from both sides of the aisle.

It’s okay to voice opposition to the Affordable Care Act and its very real issues. But the GOP has spent so long vilifying a flawed bill as the worst example of oligarchic overreach in modern history that it forgot to actually do its job and put together a working replacement. The leaders of the Republican party have come to find out that contrarianism can only get one so far. At some point you’ve got to help the people that put you office – a lesson Democrats would be wise to heed.

So, for the time being, America is stuck in a quagmire of doubt and the a future with affordable healthcare for all in this country is endangered at best. Republicans could somehow forge ahead in the face of significant disagreement and pass the proposed plan that would side with insurance company wants and make matters worse for a significant portion of the population, especially the eldest in our ranks. The GOP could falter and, in the face of mounting criticism, fail to produce a replacement, which would lead to growing strife and add another interesting wrinkle to the 2018 interim elections. It’s also possible that the different camps find common ground and work towards a comprehensive reform instead of sabotaging each other’s attempts. Is it likely? Of course not, no. But it’s possible, and a few different options have been explored by lawmakers of various nationalities.

A single-payer system has been proposed by progressives such as Bernie Sanders and can face its own unique set of challenges at enormous costs to the government, even though it has found success in a number of Western countries. The once-vilified public option has reluctantly gained a spot at the replacement table in some circles as a possible patch to the current system, though critics of the single-payer system believe the public option will send American healthcare careening into the depths of what they consider to be the hell of lightly-socialized medicine. Some believe a two-tier system is in our future, though countries like Australia have found some of the same single-payer wait time issues might exist.

By now you’ve likely picked up on the common theme: not one of these plans is perfect. Each has its own pitfalls and benefits, reflected in the menagerie of health care systems around the world.

No matter the shift in policy there will always be losers in health insurance, which is why it’s so important for those in power to look out for those who are most vulnerable to such a radical change. Mr. Obama, to his credit, tried to do so with imperfect results. It appears Mr. Trump and the Congressional GOP leaders don’t seem to be bothered by such obligations.

-JG