The only thing the Republican right has been able to accomplish after eight years of “repeal and replace” rhetoric is a failed health care insurance bill that would do more repeal than replace.
The scuttled Trumpcare bill was designed to essentially bring back the past. Those who favored that return to a pre-ACA world have apparently forgotten the past, but many of us remember it well.
Before the Affordable Care Act came to be, 32 million people did not have health insurance. Insurance premiums were increasing at more then twice the inflation rate. The most frequent reason for filing bankruptcy was unmanageable medical expenses. If you lost your job, it was unlikely that you could afford the premiums provided by the COBRA law. If you had a pre-existing condition, it was unlikely you could get insurance. If you were a cancer survivor you would be denied further insurance coverage because you had exceeded your lifetime limit. Women had to pay more for insurance than men. If you had children over the age of 18, you would now have to buy a separate policy or have them go bear. You now needed chemotherapy but realized that your policy does not cover chemo even though you have paid premiums for years. The list goes on and on.
Going back further in history, there was a time when you could not get insurance if you were 65 or older. If you lived on an Indian reservation, you could not even find an insurance company. If you developed kidney failure, there was no affordable private insurance for you at all. If you were a World War I veteran you could not get any insurance for any illness related to the war. If you lived below the poverty level, private insurance companies were totally absent. Insurance companies knew that they could not provide profitable insurance for these groups. This is why we have the Indian Health Services, the Veterans Administration, Medicaid, and Medicare.
The Republican right argues that insurance will be cheaper and more responsive if left to the states and private insurance companies. In the past state insurance commissions made no effort to control prices. And illnesses do not follow state borders. One hears the argument that insurance companies can tailor policies to specific markets and so make it cheaper. For example: Why should men pay for maternity benefits, as men do not get pregnant? Dammit! Women do not cause pregnancy — men do. Making men part of the pool that covers maternity is a rational and just approach.
Recently, Paul Ryan proposed an amendment that would establish high-risk pools subsidized by the federal government. The Republican right claims that this would permit insurance companies to exclude pre-existing conditions and allow for tailored policies that could exclude certain high cost care, therefore, making them cheaper. All past historical evidence makes this claim untenable. The real reason insurance companies want to revert to the past is so they can divide and conquer in order to maximize profits.
The Republican right claims the free market is more efficient and, therefore, would control costs. The Medicare experience proves this claim ridiculous. Medicare provides broad coverage for older and sicker individuals at lower prices than any other insurance plans. Private insurance sucks out billion of dollars from health care in the form of dividends. Returning this money to health care would greatly stabilize the system and solve the ethical problem of coupon-clippers making money on the suffering of other people.
History teaches that insurance companies will abandon any market in which they cannot make a significant profit. The corollary is that government has always stepped in to provide needed care. Why should private insurance be allowed to cherry-pick the most profitable? They should either be regulated to provide adequate coverage to the widest possible pool or get out of the way. The idea of subsidized high-risk pools is an admission that the private insurance industry is incapable of providing adequate insurance. It is better that they get out of the way. Do not repeat history! The only rational solution is to nationalize the whole system, i.e., Medicare for all.