The GOP “Pledge to America” is a joke; it greatly increases the national deficit and includes no new ideas whatever. Strikingly, however, it calls for the repeal of healthcare reform and its replacement with a Republican version. The Pledge is vague on what the Republican bill would include, but the GOP has conceded there is no way we can go back to the old status quo.
The American healthcare system is the worst among developed countries in terms of what we get for our money, the levels of coverage, and the injustices that befall families who are denied treatment or can’t get coverage due to pre-existing conditions. Providing universal coverage is difficult, but many countries have managed to do it for decades.
Universal systems fall into one of two basic types: public systems run by the government in which doctors are paid salaries instead of per-service fees, with the government deciding what treatments patients receive (or they can pay for additional services out of their own pockets); or tightly-regulated systems of private insurance. The UK falls into the first category while Switzerland has the latter.
Obama’s healthcare policy resembles the Swiss model. As yet, America has no public option and doctors are paid by individuals and insurance companies, not the government. Republicans are so opposed to government-run healthcare, like the UK’s, that the public option was never on the table (though progressives strongly favor this approach).
What Obama and the Democrats passed is actually what many Republicans proposed in the past, including Bob Dole and later Mitt Romney, who instituted a very similar program in Massachusetts. But then Republicans put themselves in a bind: instead of building off these centrist and reasonable plans, they took an ideological position opposed to anything the Democrats proposed. In addition, they stoked the fears of their extremist base with cries of socialism and death panels. As a result they’re can’t even support policies they once championed, such as the individual mandate.
But if private insurance is going to be the delivery mechanism, insurance companies will have to be so tightly regulated that they become almost non-profits, which is the case in Switzerland. Without tight regulation, private insurers will simply choose to insure the healthy and refuse insurance to the sick; this is what maximizes profits, which is what private businesses do. Without tight regulation, there is no way to deal with preexisting conditions, mandatory preventative care, and other thorny issues.
Americans love many provisions of the bill Democrats passed, e.g., the fact they can’t be denied coverage for pre-existing conditions and have lifetime caps. Republicans are trying to tell people they can have it both ways—all the benefits of Obamacare, without any government involvement. This is simply impossible: Republicans will ultimately have to choose between the popular provisions of the bill or government regulation.
Democrats were right to vote for the healthcare bill, as imperfect as it is; once the train leaves the station it doesn’t go back. We’re headed for universal healthcare in America, and only the Democratic Party can deliver it. That Party will win the healthcare battle, even if there are minor setbacks along the way.
Jason Scorse