Columns, Opinion

Lessons from the Left: A problematic health care debate under a problematic president

Up until recently, the health care debate has been a legislative one. Sure, President Donald Trump had some sort of influence, but no one took him very seriously — since he didn’t, and still doesn’t — know much about crafting policy. It was left largely to our representatives and senators — the Republican ones, that is — to figure out health care. We all know it wasn’t a very fruitful endeavor, seeing how after countless tries, they didn’t get anything done. But at the very, very least, nothing got any worse.

Well, that’s changing now. Since Congress couldn’t get a compressive Affordable Care Act repeal and replace plan passed, Trump is going to do what he does best, and tear it to pieces via executive order.

The ACA’s open enrollment season begins in two weeks, and Trump just ceased subsidy payments to health insurance providers. That means higher premiums for everyone on Obamacare — so, naturally, people aren’t going to want to stick with or sign up for a program they can’t afford.

Trump’s actions and rhetoric on the issue alone sow massive seeds of discontent among consumers and health insurance provides. Why would anyone sign up for something the president regularly berates, something they know he wants to cut, something they don’t see as a very permanent institution? And why would insurance companies enter into binding contracts they don’t consider all that binding, why would they fix their rates if they’re not getting the promised federal payments to make up for money lost?

States — even the Republican ones — hate this stuff, because insurers have been pulling out of selling ACA coverage left and right. Naturally, if Trump continues to do what he’s doing, some small counties with only a few providers might not have any affordable health care plans in 2018.

But why is Trump doing all of this? Why force the Obamacare markets into a tailspin at the expense of the most vulnerable strata of society — people who can’t afford good healthcare? Well, part of it has to do with Trump himself. He’s the country’s most vocal narcissist, he can’t even fathom fixing Obamacare because it’s a piece of legislation that’s literally got Obama’s name all over it. Another part of it has to do with Republicans’ unquenchable thirst for a health care “win.” According to Trump and everyone around him, this is going to force Obamacare to fail, and force Congress into doing something about it. Then, maybe, we will get a bill.

The funny thing is that some Republicans don’t think Trump’s strategy will help them in the long run. Rather, they think they’ll be blamed for the ACA’s failure, and that it will show in the 2018 midterm elections.

The health care debate, naturally, is problematic, and it’s been problematic for quite some time now. If we leave it up to Congress to legislate, they won’t get anything done — and if we give it to the president, especially this president, things will only get worse.

To be fair, the ACA — though an incredibly comprehensive program — wasn’t designed to last forever. Because we’ve married healthcare with free market enterprise in America, both the legislative and executive branch are going to have to make some updates, tweaking policy according to markets and demands of private insurers.

At the end of the day, the system we have is incredibly fragile, and we can’t possibly expect every single president and every single Congress to monitor and fine tune the ACA when some of them don’t even support it.

I’ve said it before, and I’ll say it again: what we need is single payer health care. You don’t often see a thorough definition of single payer, so I’ll give it to you straight. Single payer, according to Physicians for a National Health Program, is “a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands.” It depends much less on fluctuating markets, and doesn’t deal so much with private insurers. You can’t just undercut single payer systems at will, as Trump has with the ACA, because single payers are extremely robust with a massive amount of staying power.

If you’re afraid of Trump ruining Obamacare, it’s not only because Trump’s unstable. It’s also because Obamacare is unstable too.

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