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Are we all losing health insurance coverage?


I met former Supreme Court Justice Sandra Day O’Connor shortly after she retired in 2006, years before Obamacare.

We were both speakers at a conference in Washington, D.C. The justice, a person of extraordinary intellect, is generally exceptionally composed. That day she was upset. In her talk on health care she repeatedly asked, “Why can’t a nation as great and prosperous as ours provide health care for all?”

Universal health care wasn’t a Republican issue, so this seemed an unusual question coming from a prominent Republican. During the break, I asked her if someone she knew was uninsured. She said her son. I asked why. She said he couldn’t afford insurance because his child (her grandchild) had a pre-existing condition.

“This means you too are, in effect, uninsured.”

“Precisely. If they need medical care, I will, of course, help pay the bills, which could be enormous.”

A year later, I discussed my proposed health care fix — www.thepurplehealthplan.org — at The Country Club, whose members comprise the bluest of Boston bluebloods.

I started by suggesting that health care was a basic right and that the government needed to ensure everyone had coverage at an affordable price.

Immediately, a member rose and began screaming in disagreement.

I was shocked. This was The Country Club. I wasn’t a member. Neither my salary, social standing, golf game, blood tint or interest sufficed. But I knew club rules didn’t permit teeing off at your invited speaker two minutes into his talk.

The gist of the rant was, “I pay for my own health insurance. Why should I have to pay for anyone else’s?”

When my irate inquisitor paused for air, I asked him his profession.

“I’m a doctor.”

“A doctor! And you don’t believe the government should do something about the 50 million uninsured?”

“No, I don’t,” he shouted.

“OK, one more question. Are any of your relatives uninsured?”

He went pale and after a long pause said quietly, “My brother.”

“You realize, of course, that you’re uninsured.”

Another long pause. “I see your point.” Then he sat down.

This was what we academics call a “teachable moment.”

Public reaction to the proposed replacement of Obamacare with Trumpcare may prove a teachable moment for its Republican sponsors. According to the Congressional Budget Office, Trumpcare will raise the number of uninsured by 14 million next year and by 24 million by 2026.

This reflects the replacement of Obamacare subsidies with smaller Trumpcare tax credits; the failure to adjust the tax credits to local health care costs; the gradual rollback of Medicaid coverage; the huge incentives provided employers with low-wage workers (who are, on average, in worse health) to shut down their health plans and dump their workers on the individual market (raising plan costs and requiring paying more tax credits).

And: the defunding of Planned Parenthood, which provides important health care services to women; the elimination of cost-sharing of out-of-pocket expenses of the poor; the ability of insurers to charge oldsters five, not three times, what they charge youngsters and charge those with a coverage lapse 30 percent more; the ongoing ability of insurance companies to pull out of markets whose populations are sicker and more expensive.

And: the repeal of the Obamacare high-income Medicare taxes, which augurs Medicare cutbacks; the repeal of Obamacare taxes on insurance and drug companies, whose revenues are used to subsidize insurance for low-income and middle-class families; the provision of Medicaid block grants to states independent of their population’s health care needs and costs; the failure to cover abortion services.

And: insurers’ ability to offer low-cost, catastrophic-only coverage, leaving purchasers woefully underinsured; the likely disappearance of Obamacare exchanges that force insurers to offer uniform plans and keep them from cherry-picking by, for example, offering no diabetes specialists in their networks.

Yes, our current health care system — all of it — is a mess based on its cost and outcomes. But replacing Obamacare with Trumpcare violates the Hippocratic Oath: “First, do no harm.” If enacted, it will leave far more of us uninsured or underinsured, which means it will leave all of us uninsured or underinsured.

This, in turn, means we all need to save more for that unexpected call for help from a relative or friend.



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