As anyone who has been on the planet knows, health care has been at the forefront of discussions in Washington, D.C., primarily centering on the 100 most powerful men and women on Earth, members of the United States Senate.
While the terms can be confusing and convoluted, from Obamacare, the Affordable Care Act, the American Health Care Act, the Better Care Reconciliation Act, repeal and replace, skinny repeal and other iterations, involving pre-existing conditions, mandates and subsidies, the entire debate can be explained in very simple terms using basic math.
The essential question is: Who is going to pay for health care?
There is a notion by some Americans that if you can’t afford to pay for a service you don’t get the service. That works in most areas of life, but health care is different and as a society, we have not decided to take that step toward a “Logan’s Run” type of civilization that decides, for the good of the order, that after a certain age, a person should be eliminated. In fact, though, aren’t some lawmakers suggesting that if you can’t afford health care, too bad? Health care is so expensive, an illness can expose almost anyone to the open door of bankruptcy.
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The exercise going on in Washington is all about who pays. Deficit hawks look at mounting health care bills with fright, and with good reason. According to the Centers for Medicare and Medicaid Services, health care comprises 17.8 percent of our gross domestic product, accounting for $3.2 trillion in 2015, and the costs continue to rise because, quite frankly, Americans are living longer, (life expectancy is 79.6 years compared to 71.8 years in 1990). Much of the rise in life expectancy can be attributed to better medical care. But that care comes at a cost.
Other lawmakers are thinking about the human costs. Proposals before the Senate have left as many as 23 million Americans without health insurance and the chaos such a situation would create.
Before the Affordable Care Act hospitals charged paying customers more for procedures and other services to pay for those who could not afford them, but the business models of financing health care has changed and though the debate has rarely been as fever pitched, talk of how to reform the system has been going on for decades — and for all the talk, it still comes down to that single question: Who pays the bill?
Federal lawmakers want to hand the hot potato to individual states. Governors of every stripe aren’t taking the hand off. They can’t absorb the cost of care and to do so would require them to make drastic choices that would lead to their unemployment. States such as Georgia already have draconian qualifying measures that require almost abject destitution before a person can get on the state’s Medicaid rolls. And while that keeps hundreds of thousands of Georgians off the rolls, the results are, at best, counterproductive because somebody still has to pay.
People without insurance use the hospital’s emergency room when they get sick. And by the time they walk through the most expensive area of the facility, they’re sicker than they otherwise would have been had they been able to seek help sooner. But now, they are involved in a health emergency which could very well impact them — and their families — for the rest of their lives.
So as we sit and watch the debate in Washington and the various lawmakers throw complicated scenarios around, whittle each argument down to the simplest of questions: Who pays for the opioid addict’s treatment? Who pays for the child’s $100 a month asthma inhaler? Who pays for the diabetic’s insulin injection pens? Who pays for the emergency room doctor or the MRI machine? Who pays for life-saving cancer treatments?
That brings up other important questions in this health debate. What kind of country do we want to be? Do we want to be the kind of country that has a two-tiered health-care system — one for the haves and one for the have nots that rations care depending on one’s ability to pay?
Yes, that’s what this debate in Washington is all about. What kind of country do we want to live in — and more importantly die in?