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The American Health Care Act that is designated to repeal and replace the Affordable Care Act is racing through Congressional Committees towards adoption in the House and eventually in the Senate.  After excoriating the Affordable Care Act for six plus years, Paul Ryan Republicans have put forward a bill that illustrates the incapacity of right wing conservatives to govern in the interest of the vast majority of working class Americans.

The rational procedure would be to wait for the non-partisan Congressional Budget Office to score the bill.  The CBO was set up for that specific purpose so that lawmakers could have an estimate of the impact that such a bill would have.  Health care is a life and death issue and a rush to judgment before examining the full impact would be gross irresponsibility on the part of the Paul Ryan Republican leadership.

President Trump has interjected himself into the debate but he does not understand the complexity of the issues and is limited to reciting the platitudes offered on a platter to him.  For years, the Ryan rightwing ideologues have been making the case that the Affordable Care Act was a job killer.  There was no empirical data to support that preposterous notion.  To the contrary, there have been opportunities for career employment that have been created in the medical professions.  The health industry constitutes approximately one-sixth of the American economy.

Republicans of all stripes have been opposed to the Affordable Care Act because it expanded the scope of government.  The ACA in the quest to make health care affordable to Americans earning modest incomes, subsidies were provided to workers earning four times above the poverty level.  Those earning less than the poverty level were eligible for Medicaid but Republican governors with few exceptions were adamant about the expansion of Medicaid and deprived millions of citizens in their respective states from having medical coverage.

The Affordable Care Act stems from an idea taken from a right wing think-tank, the American Heritage Foundation, and was intended to expand health coverage and ensure that private insurance companies would still have a stake in the health care market.  The design of the program was based on the mandate that would require all Americans to have health insurance with the presumption that younger Turks who would not need expensive medical care would balance out the older and less healthy segments of the population.  Thus for actuarial reasons, the insurance companies would be able to make a profit. Despite the mandate, the influx of young folks was much less than was projected.

The ACA placed the insurance companies “under manners” as they could not spend more than 20 percent of income on administrative expenses and could not discriminate against those who had a pre-existent condition.  In addition, college students could remain on their parents’ insurance until the age of twenty-six and could not charge women higher premiums.  There was more emphasis on preventive care and for medicare recipients, preventive co-payments were eliminated and the cost of prescription drugs was made more palatable.

The ACA did not bring about universal health coverage but it extended significantly the amount of Americans who now had health coverage and the estimate of those outside of that medical umbrella was reduced to 9 percent of the American population.

The segment of the population that did not benefit from the Affordable Care Act were those whose incomes made them ineligible for the subsidies and many of those recipients saw their premiums rise.  The retort of the Republican American Health Care Act is not to amend the ACA but as the clarion call became, repeal and replace.

The CBO has estimated that by 2018, 14 million Americans who had health care will be deprived of coverage and by 2026 that figure will increase to 26 million.  The total figure of uninsured would be 52 million.  It is logical that the elimination of subsidies, the cessation of the Medicaid expansion by 2020 will lead to multiple millions of poor people deprived of health care coverage.

The replacement of subsidies with tax credits which will not cover the cost of premiums will force those who can access the tax credits but cannot afford the premiums to function without sorely needed health care coverage.  The notion that a return to market based health care system will provide Americans with more freedoms, with more choices and reduced premiums is simply poppycock

What is shocking is that Trump who ran and won as a populist, promising to replace Obamacare with a replacement that would cover all Americans was just campaign demagoguery.  Once elected, Trump has moved away from his populist rhetoric and has embraced right wing policies that are anti-thetical to populism as advocated by his ideological guru, Steven Bannon.

The American debate on health care illustrates that the country still thinks in frontier terms and remains the most politically backward people when compared with other industrialized and enlightened nations.  In America the health debate is about the modest Affordable Care Act and the scrooge-like backward American Health Care Act.  The American people should be demanding universal health coverage as a right just as essential as the other provisions in the Bill of Rights.  Despite the fact that America spends more of its Gross Domestic Product than any of the other industrialized countries, the outcomes fall below those particular nations. America spends over 16 percent of its GDP on health care while other countries like the United Kingdom, Canada, Germany, France, Sweden, etc., average around 10 percent of their Gross Domestic Product.

American longevity is 78.8 while that of Japan, it is 83.9, United Kingdom, 81.1 and France 82.3.  The same comparative deplorable outcomes manifest themselves in Infant Mortality Rates.  In the United States, mortality rates are 6.1 yet in the United Kingdom, it is 3.8, in Japan, 2.1 and in Germany 3.3.

All these countries with better health outcomes have universal health coverage and spend less per capita.  Rather than firming up the Affordable Care Act by introducing a public option and bringing down the price of drugs, we are contemplating a scrooge-like Neanderthal proposal that will provide millions and millions of Americans with no health coverage in the new age of Trump.  In the critical area of health care, the country is moving backwards rather than forward.

Dr. Basil Wilson