Maybe it’s because my formal education trained me to be sensitive — even hypersensitive — to words. Whatever the reason, I’m impressed and riled up when I read how House Republican leaders and some top officials in Trump administration are styling the features of their Obamacare repeal-replace bill.
Both responses because their word choices artfully appeal to widely-shared values, while obscuring basic truths that anyone who reads even a summary of their plan can see.
And just because neither the Republican House leadership nor Trump could herd enough of their cats to pass their final bill, doesn’t mean we’ve seen the end of this. Some notable examples then.
Access to Coverage. A favorite word. House Speaker Paul Ryan says it’s the Republicans’ “job to have a system where people can get access to affordable coverage.”
A Republican House staffer, speaking anonymously and thus perhaps less focused on the selling the work-in progress, said, “We would like to get to a point where we have what we call universal access, where everybody is able to access coverage to some degree or another.”
Now, access isn’t the same thing as ability to buy. For example, I have access to a full-length mink coat. The coat’s in a store I can get to. I can walk right up to it. And it’s great coverage, especially when in cold weather.
So a poor person can review a health insurance policy, with ample coverage, a minimal deductible and small co-pays. Doesn’t mean s/he can pay for it.
Now that we’ve got credible estimates of the many millions of Americans who’d no longer have health insurance, Ryan harps again on access, coupled with another favorite word — and not only in the healthcare context.
Choice. For families, Ryan says, access means, among other things, “more choices.” Well, who doesn’t like having choices? Do we like being told we must do or have some specific thing — or can’t?
But the bill, as I’ve just said, doesn’t mean more choices for lower-income families, except the choice of going without health insurance — or buying one of those low-cost, high deductible plans.
Ryan touts the larger maximum people can contribute to a health savings account, avoiding the corollaries, i.e., that only people with high-deductible plans can have them and that those who live paycheck to paycheck don’t have money to stash away.
Only 6% of families with incomes less than $30,000 a year contribute anything to an HSA now. More than half the families that contribute have incomes of at least $100,000 — a tax saver for them, rather than a needed savings account.
Freedom. When Ryan was asked how many Americans would lose coverage if the Republican’s bill became law, he said he couldn’t answer. “People are going to do what they want with their lives because we believe in individual freedom.”
And indeed we do, but only up to a point. We don’t believe everyone should be able to do whatever they want, especially when what they would cause harm to others, directly or otherwise.
In the immediate case, people would be freer to go without health insurance, since the bill would eliminate the annually-growing penalty for that.
But they’d drive up premiums because most would have reasons to believe they’d remain healthy — at least for awhile. But if they then had a medical emergency, a hospital would have to eat the costs of treating them.
An immigrant from Finland cites several other instances of the Republicans’ using “freedom” as a selling point and, as her op-ed’s headline says, explains why it’s “fake,” in contrast to the freedom she had before.
Care. The Director of the Office of Management and Budget asserts that the Republicans’ goal isn’t health insurance coverage nor a plan people can afford.
It’s care they can afford. He cites his family’s high deductible when he was in the House of Representatives, earning considerably more than would qualify them for a tax credit to subsidize it, let alone one for a family eligible for the highest.
We earlier heard something, though more extreme from the Secretary of Health and Human Services — a former orthopedic surgeon and then Republican House member who proposed his own version of repeal-replace.
While in the House, he said that he “knew oh so well how the intervention of the state and federal government into the practice of medicine destroys the ability to take care of people.”
Seems fair to gather what he means from the reported views of a radically right-wing professional organization he belonged to — minimal, if any health insurance regulations or medical quality standards, e.g., that physicians be licensed to practice, no vaccination requirements and no Medicare at all.
Well, save me from care so free of intervention. But these views hardly reflect what the majority of doctors believe — even those represented by the traditionally conservative American Medical Association, which has decided that the repeal-replace is far worse than the “imperfect” law we have.
Rebuttal Story. The Washington Post recently published a column by a doctor at primary care clinic that expressly rebuts the interference with care claim — and, by example, the other negatives that the Republicans’ word choices imply.
The doctor tells the story of one of his patients. Mr. R. first came to him when he got health insurance, having had none before because he couldn’t afford it.
The Affordable Care Act changed that, enabling him to purchase a plan that cost him less than $50 a month, thanks to the subsidies low-income people receive. But that’s not all.
Mr. R can neither read nor write. So he could hardly use the online system to choose and actually apply for a plan. He had the help of a navigator — a trained, unbiased helper — whose role the ACA established.
So he’d gotten help with logging on and entering some basic information. The the system then determined he had somewhat too much income qualify for Medicaid. So it kicked him over to the health insurance exchange.
The navigator explained terms like “premium” and “out-of-pocket maximum” and helped him fill out the forms. In short, as the physician says, “the federal policies … worked synergistically.”
Mr. R had — and still has — access to coverage, freedom, choice and care from a caring doctor. What “some politicians … seem not understand,“ the doctor says, “is that without the ACA, I wouldn’t have a relationship with patients like Mr. R at all.”
They actually do, I think, just as they understand the weasely way they’re using terms like “access,” “choice” and the rest. But what’s the alternative? To acknowledge that their bill would cause nearly as many people to have no health insurance than before the ACA?