Think About It: Careful what you wish for

Here’s what we know about the politics of health care in America if we listen to and watch what politicians do. The Republican party (Repubs) and administration are continuing their efforts to dismantle the Affordable Health Care Act (ACA or Obamacare), most recently by supporting a district court’s ruling to strike down the act in an appeals court. At least they know what they want or in this case, don’t want.

Collectively, the Democrats (Dems) don’t seem to know what they want; individually, everyone has an idea which usually includes some version of universal access to health care at some point or another. The plan or slogan frequently heard from Dems is “Medicare for All.” Oddly although not so much, Repubs like it too because it gives them a chance to claim all Dems are “socialists.”

Politicizing health care is not new. Unfortunately. Our politicians have twisted health care, what I consider meeting a basic human service as opposed to a profit-center for big business, into a malleable program vulnerable to political vicissitudes of transitions of power.

The usual issues are around government involvement in regulating and payment versus letting market forces do it. There are philosophical or ideological underpinnings to the arguments for and against both approaches. I have much more sympathy around those arguments than the current president’s approach which is to simply destroy anything the prior president accomplished.

Chaos as a solution?

Plunging into the chaos of system overhaul every few years is a stupid way to incentivize a complex industry attempting to stay state of the art with fast developing technology and achieve safety, quality and sustainability. It’s a crassly inhumane way of creating individual winners and losers depending on ability to afford premiums and/or co-pays/deductibles.

“Today I know what I will be paid for service, but not following the next election,” laments the health care provider who must decide on a large ticket equipment purchase or expanding services.

“Today I know I can afford insurance, but I don’t know if I will be covered following the next election,” says the worried person with a pre-existing condition.

Unpredictability weakens the provision of health service as well as access for the patient who may or may not be financially eligible for medically necessary services.

We Americans currently have a mix of marketplace and government in our health care. Medicare and Medicaid are insurance programs for the 65-year-plus and low-income persons. The ACA/Obamacare expanded the Medicaid program by providing premium support for additional low-income persons.

In addition, the ACA/Obamacare also opened private insurance to millions of persons not covered under either Medicare, Medicaid or an employee benefit plan by creating larger insurance pools that allowed insurance companies to balance the risk.

Insurance pools only work if there is a balance between people who need health care and those that don’t. The ACA/Obamacare sought to stabilize a pool by mandating either getting coverage or paying a fine. The last feature is the one that the current administration disabled and is being contested in the courts.

Despite the Repubs’ budget cuts to promotions and programs that assist people in signing up for ACA/Obamacare, it remains a popular program.

Intended and/or unintended consequences

The irony to me of these destructive actions is that ACA/Obamacare attempted to create a uniquely American health care system that involved both private and government insurance. Even though it was a Republican plan put forth in lieu of “Medicare for All,” not a single Repub voted for it. What a shame that President Obama dropped the public option to gain consensus.

Alas, Repubs are goal-directed to destroy it and the standards of comprehensive coverage that included covering people with preexisting conditions or allowing college students to stay on their parents’ plan.

Destruction of ACA/Obamacare will mean millions of people will lose coverage. Serious Sequimites need to recognize the resulting threat to our Olympic Medical Center when a source of revenue is replaced by a significant increase in uncompensated care and revenue taken from providers to help finance ACA/Obamacare is never replaced.

Conversely, “Medicare for All” promises to all but set fire to OMC’s ability to provide services at the level we currently enjoy. We all need to understand that private insurances pay more than Medicare and Medicaid for the same services. As a result, private insurance covers part of the loss incurred when Medicare pays less than it costs.

We need to get our heads around the implications of Dems “all” and Repubs “none.” Either one has adverse consequences to the vitality of our locally governed health care system. The Repub administration already has set in motion reimbursement cuts that could if allowed to continue move services from Sequim to Port Angeles.

We should be pestering the current president, Senate and House to provide a healthy environment for all health care services and one that focuses on access and affordability. We should insist that private industry and government work together to achieve a stable, accessible and affordable delivery system in all parts of America for all American people.

It can be done, but requires de-politicization of healthcare first and then the hard work of designing a plan that accommodates the market and the healthcare needs of the people.

In the meantime, be wary of political slogans and simple solutions and be very careful what you wish for.

Coming up next: “It could happen, you never know” … a story of one journey through unexpected illness and insurance approvals/rejections.

Bertha Cooper spent her career years as a health care organization and program administrator and consultant and is a featured columnist in Sequim Gazette. Cooper has lived in Sequim with her husband for nearly 20 years. Reach her at