Sunday, March 12, 2017

The Moral Bankruptcy of the GOP's Obamacare Repeal

The moral bankruptcy of today's Republican Party - and the 81% of evangelical Christians who voted for Der Trumpenführer - cannot be stressed often or strongly enough.  Nowhere is this moral bankruptcy more evident than in the GOP drive to repeal Obamacare.  Despite the lies and smoke screens being floated by Republicans, the underlying agenda of Obamacare repeal is to provide huge tax cuts to the wealthy (one estimate of Obamacare repeals is a $270 billion gift to high income households) while depriving millions of coverage,   Left without coverage, the uninsured will be left to secure treatment at non-profit hospitals that must treat - at least for now - the uninsured through their emergency room operations, the most expensive and least efficient method of healthcare delivery.  This, of course, leaves hospitals forced to recoup these costs by drastically raising prices for those with insurance and/or the ability to pay for care.  The result?  Americans pay two to three times more for healthcare than any other advanced country, all of which have some form of universal coverage.  An op-ed in the New York Times written by a hospice nurse aptly describes the GOP's moral bankruptcy on this issue.  Here are excerpts:
Imagine a car crash. There’s twisted metal, broken glass and the low moaning of an injured human being. An ambulance arrives, and two emergency medical technicians get out.
Now imagine this: One E.M.T. moves to the wreck, sees the wounded driver — a man, the one who’s moaning — and before doing anything else, flips down the driver’s seat visor, looking for an insurance card that isn’t there. Then he stands back up, frowns and shakes his head.
“No insurance?” his partner calls out. The E.M.T. shakes his head again.
Maybe nothing this extreme would ever happen. But contrary to what some congressional Republicans say, a world in which it could is the logical conclusion of their efforts to repeal the Affordable Care Act and set per capita caps on Medicaid — and the all-but-explicit desire among dozens of hard-liners.
The House leadership is making gestures toward covering the uninsured by retaining popular portions of the A.C.A. and offering a suite of “market-based” programs like health savings accounts and tax credits. In some ways, that’s their problem; if the Republican bill designed to replace the A.C.A. fails, it could well be because of pressure from the far right, which is insisting on repeal, full stop. For a large number of Congressional Republicans, any effort to cover the costs of care for the poor and uninsured smacks of socialism and unwelcome government interference in the market.
It’s easy, politically, to make that case against the A.C.A., since the Republicans have spent the better part of a decade demonizing it. And it’s easy to forget how bad things were for tens of millions of Americans before Obamacare.
To begin with, consider the numbers. A percentage of the 20 million Americans who gained insurance under the A.C.A. will very likely lose it if the law is repealed. Even with the provisions in the proposed American Health Care Act, the “replace” part of the Republican approach, an estimated 10 million people would fall off the rolls. . . . . a vast majority, will be terrified by the idea of living without health insurance. As was the case before the passage of the A.C.A., many of the uninsured — the terrified and relieved alike — will end up using hospital emergency departments for their health care needs, even if they cannot afford it.
[T]he opposite of the A.C.A. is not a free market. The Emergency Medical Treatment and Labor Act, a 1985 law, requires that hospital emergency departments treat all comers. So, while some uninsured patients will forgo care after repeal of the A.C.A., others, especially the seriously injured and mortally ill, will secure the care they need even if they can’t pay for it, even if they know they will never be able to pay for it. And in the end, all of us pay for that care through higher insurance premiums, increased hospital costs and overtreatment of the (paying) insured.
[F]rom decades of debate leading up to the A.C.A., the only way to rein in health care costs in a system without some form of universal public health insurance is to place limits on care for those without insurance or the ability to pay for it outright.
I remember a recent case, here in Pittsburgh. A woman, young and fit, moved to the city to be with her boyfriend. She didn’t have health insurance because she was new in town and hadn’t yet found a job. But she wasn’t worried; her youth, she thought, guaranteed her health.
But it turned out she had A.M.L. — acute myelogenous leukemia — a killer disease, the medical version of a high-speed collision. The first round of curative treatment required a six-week hospital stay, multiple infusions of chemotherapy and intensive round-the-clock nursing. And that was just the start. . . . . Treating A.M.L. can cost upward of $100,000. Neither she nor her boyfriend had that kind of money.
If the A.C.A. is scrapped and Medicaid is converted to per capita caps, partly to ensure that everyone who gets care pays her fair share, I worry about what will happen to patients like this young woman. Abandoning this patient to her terrible disease simply because she couldn’t pay for the cure feels sad and wrong. Just as sad and wrong as abandoning an injured patient at a crash site.
House Speaker Paul Ryan and others would take mock offense at the idea that they’re willing to let people go without care, but it’s the unavoidable logic of their drive to undo Obamacare — the part that Republicans would rather not talk about, even as it drives them to ram through the legislation without debate.
People without insurance and little money are still going to need care, some of it very expensive. To deny these people care by restricting their access at the source — ambulances, emergency departments, hospitals — would reflect equity in a you-get-what-you-pay-for model. But the human cost of limiting health care to those who can pay would be higher than any of us should be willing to bear.
 Congressman Joe Kennedy, III, correctly condemned the GOP in his statements - which the GOP chair cut short because they were all too true.

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