WASHINGTON. The debate about crafting a national healthcare policy that achieves all key goals illustrates the wide and continuing differences between America’s two dominant political parties. In 2010 the Affordable Care Act (ACA), aka Obamacare, was passed without a single vote from the GOP in either the House or the Senate. In 2017, the revised GOP healthcare law that passed the House of Representatives fell one vote short in the Senate. Predictably, it received no Democrat votes.
Why can’t the GOP and the Democrats agree?
The reason for the lack of agreement between these parties on national healthcare policy involves the dramatically different priorities of each side. Until they reach consensus – highly unlikely at present – it is also highly unlikely that they will ever pass a bipartisan bill. While a general consensus exists on what key healthcare goals should prevail, it’s the prioritization of those goals that lies at the heart of the problem.
Cost, quality and coverage. These are the three key areas any new or revised healthcare legislation must address. All seem to agree that health care costs should be as reasonable as possible; that any healthcare plane should provide for the highest quality care; and finally, should cover as many people as possible. But as for the order in which these three priorities should be addressed? No one seems to agree.
Ideally, the nation earnestly desires to achieve all three goals. But when we list them in order of importance, we quickly discover that achieving one top priority goal could likely result in the inability to fully reach one or both of the remaining goals.
The GOP takes the traditional route
When it comes to establishing a national healthcare policy, the GOP generally agrees that the quality of care must come before the other priorities. The party believes that Americans should receive the highest quality healthcare possible. That means, in turn, that Americans should have access to the latest medical advancements and to the most technologically superior equipment and medications without delay or bureaucratic entanglements.
The GOP would rank cost second on their priority list. The high-quality care they endorse, must also be available at the most reasonable price to average American consumers. The GOP recognizes that – given the nature of the healthcare market, the need for expensive research, and the cost of vetting new treatments coupled with a highly inelastic demand – high costs may be the inevitable result. But, they believe, by applying free-market policies that encourage competition among pharmaceutical companies, hospitals and healthcare businesses, prices can be held down.
Thirdly, the GOP would like to see many if not all Americans gain access to the high quality, reasonably priced healthcare they envision.
For the most part, the GOP ranks its order of healthcare goals traditionally: quality, cost and coverage. The Dems, however, insist on a different order of priorities.
Dems see things differently
The Dems, and particularly their increasingly prominent socialist wing, insist that as the top priority of any national healthcare policy, every American must have access to healthcare. Indeed, the party believes that healthcare is “right” and not a privilege. For that reason, they regard universal coverage as their top goal. The ACA demonstrated that priority by “forcing” all Americans to buy healthcare coverage insurance or pay a penalty. The US Supreme Court ruled this a tax.
For Dems, the priority was: coverage, cost, quality
The goal of ACA was to cover 100% of the population and the Dems though this was achievable. They claimed that every industrialized country operated under this assumption. That is, the believed that every industrialized country regarded universal or near-universal healthcare coverage as its top priority. But beyond that, they failed to look beneath the hood.
Secondly, the Dems want the cost of healthcare to be affordable to all Americans regardless of their ability to pay. That’s why the ACA provided subsidies for low-income people who could purchase their insurance on government-created exchanges. By having government control much of the healthcare market, they theorized that the government could somehow control prices to keep consumer costs low.
Finally, having theoretically accomplished the first two goals, the Dems wanted high-quality coverage for all. Through the ACA, an estimated 20 million previously uninsured Americans (about 6% of the population) got healthcare coverage, often for the very first time.
But the law failed to add any new doctors or other medical professionals or make provisions for this. That resulted in lower quality care for the Americans who previously had insurance coverage. The reason? Without more available healthcare professionals, ACA pointed in the same direction as other national healthcare plans. That direction: healthcare rationing.
How’d that work out for the Dems and Obamacare?
The ACA attempted to address this issue by a simple expedient. They chose to “mandate” quality healthcare by only permitting insurance plans that covered a full range of services. Permitting “bare bones,” or limited coverage plans that could radically reduce costs was not an option. The party reasoned that this action would improve the quality of care. After all, the goal was to have all Americans covered in virtually all situations, especially including preventative care. However, in so doing, ACA immediately ran afoul of the cost component. Congress has grappled with inconsistencies in these areas ever since.
Most Americans believe the country needs a new national healthcare policy. Some believe we should start from the very beginning with a clean slate. Others believe we can modify the existing system. Either way, until Congress can gain a consensus on the nation’s healthcare priorities, building a solution that results in better healthcare at a reasonable price covering as many people as possible will prove difficult if not impossible to achieve.
—Headline image: Doctors. Public domain image via Pixabay.com.