Providing a health care is extremely costly everywhere. Rich countries nearly universally provide a health care system that allows all citizens to get needed health care. Nowhere is it perfect and nowhere is it cheap. And nowhere is it more of a mess than in the USA.

Sadly those we elect in the USA have continued for the last few decades to keep the USA healthcare system the mess we have now. The Affordable Care Act took a relatively small step in addressing several of the most flawed aspects of the USA system. It left unaddressed many of the major flaws. Instead of taking where we are now and making improvements to address the problems left from decades of Democrat and Republican created and maintained USA health care policy all we have had are demands to “repeal Obamacare.”

This is exactly the type on avoiding improvements to maintain the existing (for the last few decades) broken healthcare system those in the USA must live with. Cutting hundreds of billions from the budget to provide health care to the elderly is not improving the health care system.

Making next to no attempts to actually improve healthcare outcomes in the USA shows how flawed the current process is. It continues the behavior of the Republicans and Democrats for the last few decades. It is sad we continue to elect people behaving so contrary to the interests of the country.

The exceedingly costly health care system in the USA is in need of a great deal of work to improve the government policy that results in the mess we have now. Some of the huge issues we face.

photo of the Capital in Washington DC by John Hunter.

• Pre-existing conditions – this has long been a huge problem with the USA healthcare system and one of 2 major things ACA dealt with well. ACA greatly improved the USA healthcare system in this area, something that Democrats and Republicans had failed to do for decades. Current attempts by the Republicans are to gut these improvements. This is a completely unacceptable area for all but the most extreme people to even be looking at. That the Republican house members approved this radical removal of health insurance coverage from tens of millions of people and the vast majority of Republican senators has not expressed outrage and such attempts to punish those who have been sick in the past is pitiful. The USA even with the ACA does a much worse job on this measure than any other rich country in the world.
• Medical bankruptcy – due to the decades of poor leadership by the Republicans and Democrats the USA is the only rich country with this as a macro-economic factor. The ACA made small moves to improve this but much more is needed. Instead of improving the USA healthcare system to deal with this long term problem the current Republican efforts will great increase the number of medical bankruptcies in the USA if they succeed in their efforts.
• Massive cost-tax on all economic activity due to the costs of the USA healthcare system. The USA healthcare system costs twice as much per person as other rich countries (there are few countries with costs that have costs which the USA “only” 50% or 75%… but overall it is twice as costly) with no better outcomes than other rich countries. ACA did nothing to improve this (certain aspects of the ACA did but other aspects balanced those out), the new plans are not going to do anything to improve this (in a minor way it is possible reducing medical care for the elderly could reduce costs by having people die much sooner but given the mess of the USA healthcare system for many reasons the huge reductions in Medicare and Medicaid are unlikely to actually result in cost savings that are material).
• Tying health care to the employer – The USA is one of the few rich countries to do this. Combined with refusing or providing only inadequate coverage for those with pre-existing conditions this is a great barrier to small businesses and entrepreneurship. ACA didn’t address this directly by eliminating the pre-existing condition failure it did greatly reduce the harm this causes the USA economy and individuals in the USA. The current proposals don’t address the problem and exacerbate the issue by returning the huge problems the USA system has in dealing with pre-existing conditions (it would be slightly better than before the ACA but much worse than what we currently have with the ACA).
• A huge burden on individuals of dealing with insurance company paperwork, fighting with the medical system and insurance companies… Neither ACA nor the current plans made any improvements in this area.
• The USA pays much more for drugs than any other country. This is directly the result of decades of failure by Democrats and Republicans to create sensible healthcare system policies for the USA. Neither ACA or the current plans made any significant improvements in this area.
• Of interest to the readers of this blog the current USA healthcare system doesn’t deal at all well with the reality that tens of millions of USA citizens travel and live overseas. This is a complicated issue but it has been unaddressed for decades. It is pitiful that ACA didn’t address it and the current plans don’t address it. Even things that would be able to save tens billions of dollars by allowing healthcare to be preformed overseas (at much lower costs) for say Medicare are not addressed. There are complexities in how to craft policy to save tens and hundreds of billions of dollars this way. So it isn’t something you can expect to be addressed in a year or two. But they have had well over a decade since the obvious huge savings potential has been apparent and nothing. When you are going to cut health care benefits of the elderly to save money and don’t bother using wise policy to save money without reducing the care people receive you are failing as policy makers. And we are failing by continuing to elect these people that decade after decade fail to make wise policy decisions and instead force us to suffer with a poor healthcare system.
• Transparency of health costs – The situation is horrible and has been horrible for decades. ACA and the new proposals don’t address this in any significant way.
• Affordability and availability of health insurance – the ACA made substantial progress in this area by providing subsidies to the poor and by eliminating usurious costs around pre-existing conditions. The Republican proposals would again eliminate much of the gains but also again would leave part of the gains made by ACA in place in this area.

I am sure there are more very critical aspects I have not included in this list. The main points however are not going to be effected by that oversight.

• The 2 political parties in the USA have done a horrible job of setting the healthcare policy that determines the cost, hassle and quality of healthcare citizens receive.
• ACA made some significant improvements in dealing with pre-existing conditions. The Republican proposals with make things much worse in this area.
• ACA made small but significant improvement in making health care available and somewhat affordable.
• For all the bluster nearly 0 significant, long-term USA healthcare system problems are even addressed in a minor way with the current proposal. It mainly cutting a huge amount of health care for the elderly and help to let the poor in the USA afford insurance and returning the denial of health coverage if you have been sick (if you are not hired by a large organization that mitigates pre-existing conditions after a waiting period – so again creating huge problems for entrepreneurs and small businesses).

The whole Republican process avoided dealing with actually improving the healthcare system. This is typical of most of what our elected officials have done for decades. We have to stop re-electing those that cause such failures to take place year after year.

We need action to be taken on concrete measure to improve the USA healthcare system to make it as cost effective as even the average rich country. If we did that the savings would dwarf the saving we can get by cutting Medicare and Medicaid by hundreds of billions or by preventing those with pre-existing conditions from getting coverage. Doing this requires hard work to research, evaluate, experiment, institute policies those giving you lots of cash don’t want instituted, etc.. So far we have elected people that refuse to do this. Things look very bleak until we chose to elect people that actually want to do the hard work to make things better instead of huddling behind closed doors and coming up with ways to cut healthcare benefit for our citizens while doing nothing to improve the healthcare system.

One of the ideas included in the latest Republican plan is the type of idea we should experiment with. The idea is getting wide-spread criticism because of what it aims to do and what it will do given the existing healthcare system. The idea that needs to be explored is how we can provide adequate healthcare for everyone at a cost we can afford. We can’t afford the costs we have now. By providing good but not as gold plated coverage as is now required we can reduce costs and increase coverage.

But turning this concept into effective policy and continually adjusting that policy and government support as we learn from what happens in the real world requires thoughtful, evidence based decision making. This idea of creating and adjusting policy based on evidence from experiments is counter to the entire thrust of our modern political parties. Without trustworthy government practice and political oversight it is easy to see the criticism of the stripped down insurance coverage as just (pre-existing conditions in another form and a way to reduce coverage for those with the government health insurance those voting on the plan have).

I believe the basic idea has merit. Of course many of those who would now vote for it immediately called plans to reduce costs by judging the value of health expenditures on outcomes “death panels” even though no panels existed… It is easy to see why people don’t trust a proposal to ration care via reduced coverage health plans as a honest attempt to bring sense to health care spending given the past and current rhetoric and practices of those making such proposals. If you don’t have open hearings, if you repeat non-sense mantras like “repeal Obamacare,” if you don’t evaluate scientific evidence to determine what policies make sense on matters such as (pollution, climate change, vaccines…) why would you expect someone to believe you are acting in good faith now?

The current Republican proposal is a disaster. It is obscene it is considered as remotely close to an acceptable change to the USA healthcare system by any but the most anti-healthcare advocates in the country.

Only the most simplistic idea has much merit. Costs need to be controlled. But that needs to be done by smart people working hard for years on many different experiments to improve the health care system. Just going backwards to make healthcare less available, more costly for individuals and reducing health care support for the elderly without and efforts to improve the system should be unacceptable.

What we need is to elect people that will take ownership of possible system improvements (such as less costly coverage that sensibly reduces what is covered and stoping the USA from paying much more for drugs than every other rich country and reducing medical bankruptcies and moving the USA to having a burden no worse than the median burden of other rich countries for dealing with paperwork created by the healthcare system…). Those efforts will greatly benefit the country and each of us. Instead we elect people that hide away and create policy without open debate, without testing policies in the real world and adjusting based on what we learn. We need to elect people dedicated to improving results not those interested in repeating slogans and avoiding any actual work on actually making things better.

Related: Out of Pocket “Maximum” – Understanding USA Health Care Costs