Saturday, September 23, 2017

The GOP's problem with Obamacare replacement, failure to recognize: shifting sands of public opinion

A version of this was published in the Sky Hi News Sept. 27, 2017

Listening to GOP apologists on TV , their explanation for the unpopularity of their replacement plan for Obamacare is "people do not like change" or "they like the devil they know better than the devil they do not know". The latter is probably more true than the former except the public knows both devils and understands the difference. The GOP in Congress has underestimated the intelligence of the public in general and they failed to understand that there has been a dramatic shift in public opinion since the election. Promises made then have not taken that into account.The GOP's stubborn pursuit of keeping campaign promises as the singular motivation and strategy shaping their bills fails to realize that public opinion had shifted under their feet.
Polls have shown that voters' approval of the GOP replacement plans are approved by a measly 17 to 24% of voters.(May to November 2016, country was somewhat evenly split) The cost of health care is a fundamental pocket book , a quality of life , or even a life and death issue for those families who have low to average income. If their incomes were high enough to cover the costs of health care, there would be no issue. It does not; that is reality. Illness and disease hit families where it hurts or could hurt. They may gripe about Obamacare, but they know it would be worse if they did not have it .The opponents of the GOP plan, ranging from every stakeholder, from insurance companies to patient and disease related advocates to every facet of providers, have verified that their fears are justified, that the GOP plan would hurt them, their families, and their fundamental economic well-being.. .. The expression of their fears in marches, protests, sit ins and other contacts with their Senators and Congresspeople, may not have moved every GOP representative in Congress, but the message these actions convey has served to educate everyone else.
The public has also been educated to know that there are a variety of choices besides the take it or leave it GOP bills. The menu ranges from credible ways to fix and improve Obamacare to Medicare for All . They do not have to make the choice just between Obamacare and the bitter lemon of the GOP bills. There are other ways to save and improve their health care coverage.
Sarah Huckabee Sanders, the press spokesperson for Pres. Trump, made a broad statement recently that called Medicare for All, a single payer system being promoted by Bernie Sanders, a "terrible" idea. I distinctly remember early in the Tea Party movement angry older persons parading, protesting, and holding signs reading "Don't let government take my Medicare away from me". This big bit of ignorance that Medicare was a government program, was was put to rest as those Tea Party folks realized that. What most of the public has not yet realized is that both Medicaid and Medicare are single payer systems, but nonetheless support for those programs is driving the opposition to the GOP plan to cut Medicaid by large amounts. That Medicare will have financial difficulties in the future is true. Like Obamacare, there are fixes. Obamacare had cut the cost of health care enough so that costs did not increase as projected before Obamacare, so that twelve years were added to Medicare's solvency. . So popular is Medicare, Trump pledged not to touch that program during the campaign. However, he also pledged to replace Obamacare with something better , a promise he has not kept. He has supported the truly "horrible" GOP plans to leave 30 million without affordable insurance.
What is true is that there is no free lunch in health care, and if Medicare for All is too expensive to be self funding, tax payers will have to make up the difference. On the other hand, there is a tradeoff with lower out of family and individual out of pocket costs. There is a realization that the US is needlessly paying two and a half times more than other countries in the world who have embraced single payer programs. That is a debate worth having. It should be held in public and in Congress. That process is called "regular order". It should not be rammed down throats without knowing the impact as the GOP just tried to do with their Graham/Cassidy bill..
Medicare for All may not win out in that debate. Switzerland has a system similar to Obamacare , subsidizing private insurance to make it affordable. It differs from the US in big ways, though, since it takes the place of Medicare retiree and employer plans and it mandates all to have insurance through their system. They have strict price controls, too. Recently, when the Swiss had a chance to adopt a single payer system. they voted to keep the private insurance based status quo, even though their costs are the highest in Europe.

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