Discussing Obamacare Replacement With A Republican Congressman

House Republicans have finally released their plan to replace Obamacare. I have a lot of concerns about the plan, such as whether the tax credits will be sufficient for low income families to afford health insurance, and their attack on Planned Parenthood.

I am going to wait until I have a chance to look at the details of the plan to discuss it in depth, but for other reasons I have found it a good day to blog about health care. Hours prior to the release of the plan, I met with my conservative Republican Congressman, Bill Huizenga, along with a few colleagues, to discuss health care. I figured it would be futile to change the mindset of a conservative Republican, but when I received the invitation I also thought I should make the attempt to try to explain how health care really works. After all, there is zero chance of changing anyone’s mind if no attempt is made to persuade them. I was also appreciative that he was willing to meet with a group which strongly disagreed with him on the issue, while many Republicans around the country are reportedly hiding from their constituents.

The first time I spoke today I made a point of explaining how I am self-employed and have purchased health care on the individual market for my entire life. Therefore I could definitely state that high premiums and high out of pocket expenses, often cited as a failing of the Affordable Care Act by Republican, have always been a characteristic of the individual market–and are not something created by Obamacare.

Discussion got bogged down for quite a while over philosophical issues, especially when someone referred to health care as a right. Congressman Huizenga disagreed. While I managed to get out most of what I wanted to say today, in a conversation with multiple people present, sometimes the topic changed before I got a chance to speak. I didn’t get a chance until after the meeting while speaking to a colleague that I can understand a Republican’s position in not seeing health care as a Constitutional right in the same way as civil liberties specifically expressed in the First Amendment. After all, the Founding Fathers would have never conceived of health care being as expansive, and expensive, as it is now. However, regardless of whether you want to call it a right, access to affordable health care is both highly desirable, and something which is expected in a modern, advanced, industrialized society such as the United States. We should do it regardless of whether you want to label it a right.

The limited nature of assured coverage in the United States, compared to the rest of the world, was an underlying thought in many of our comments. It did come up that 1) the sick can show up to the Emergency Room and will not be turned away and 2) a significant portion of the Medicare population consists of the disabled. In typical Republican dodging of the issue, the Congressman at one point tried to claim that this does provide some form of basic health care as people can go to the Emergency Room. I pointed out that it is one thing to receive coverage in the Emergency Room, but this does not mean that people will receive necessary follow up medical care, especially for the types of chronic medical conditions I typically treat, such as diabetes, heart failure, and emphysema. Initial stabilization in an Emergency Room is both costly and not adequate health care. Plus an Emergency Room physician present pointed out that being seen does not mean patients do not receive large bills, which could be well beyond their ability to pay.

Congressman Huizenga responded that the disabled can receive coverage on Medicare, but I pointed out that people with chronic medical problems are not necessarily disabled, especially if they receive adequate medical treatment. Someone with diabetes, for example, can live and work for many years with the condition. However, without adequate care, twenty years down the road they are far more likely to develop problems such as heart attacks, strokes, and renal failure.

The Congressman’s philosophy on limited government (which, like most Republicans, is terribly selective, ignoring everything from infringements on reproductive rights to today’s revised anti-Muslim travel ban), also influenced his responses. Before his arrival I had discussed with others how market solutions have not worked well, with insurance companies having developed a business strategy based upon collecting premiums and then finding ways to deny care. Congressman Huizenga brought up irrelevant matters such as restrictions on choice present in Canada and other countries which Americans might not tolerate. The typical Republican scare stories. My response was simply that we do not have to adopt the restrictions which he mentioned, regardless of what other countries have done. One point I did not manage to get in was that in the United States, private insurance plans are often far more restrictive on the choices which patients and physicians can make than the government Medicare program is.

The physicians present generally saw Obamacare as an improvement over the previous system, but not going far enough, with Medicare for All being seen as a preferable solution. As a couple of us discussed afterwards, this is a far easier sell for physicians, who see first hand the amount of time and money wasted in having to deal with multiple different insurance companies, with  multiple different sets of rules. Plus this has the huge advantage of taking the astronomical profits received by the insurance industry, and using that money to actually provide health care. (Medicare for All was promoted by Bernie Sanders in the 2016 nomination battle, leading to politically-based opposition from Hillary Clinton.)

If Medicare for All is too hard a sell immediately, I, and others, suggested phasing it in. I also mentioned ideas such as the public option and the Medicare buy-in which were considered when the ACA was being written, but died when the two most conservative Senators voting with the Democrats (Joe Lieberman and Ben Nelson) opposed the ideas. Either would help with the high costs on the individual market.

The  higher cost for caring for older individuals, with some of that cost spread to the premiums of younger purchasers, is a major problem in health care coverage.  I doubt insurance companies even want to cover their older customers, who are responsible for the bulk of their costs. Either outright lower the Medicare age (even if gradually, such as initially to 50 or 55, and ultimately to around 40) or allow a Medicare buy-in.

After the Congressman left, his Legislative Director remained for a brief time and suggested that Americans would not go for expanding a government program such as Medicare. While a typical Republican thought, it does not hold up. I pointed out that we all do wind up on a government program, with most people going on Medicare at age 65. Not only are Americans failing to rebel at the though of going on Medicare at age 65, many look forward to the opportunity. Remember all those tea party protests with signs like “Keep Government Out Of My Medicare.”

My parting comment to Congressman Huizenga before he left was that Republicans must move beyond their anti-Obama rhetoric and actually address the problem. I related how for the past eight years I have often heard patients blame Obama for anything wrong with the health care system, even if it was over matters not even related to the Affordable Care Act. However, in early January, before Donald Trump even took office, I started to hear patients blame Trump for their healthcare problems. Republicans now “own” healthcare and must deliver.

I have my doubts as to whether the plan released today does deliver, but I do want to take a look at the details beyond what is in the initial news stories I have read.

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