With the American Health Care Act headed to the Senate — and possibly President Trump’s desk — it’s important to step back from the debate over the bill’s details and recognize two essential truths about American health care.
First, health care in the United States costs much more than in other developed countries, and on average the outcomes are worse. Second, any plan that focuses primarily on reducing the cost of insurance will inevitably lead to less access to care. Indeed, whatever Republicans say about high-risk pools and other ways their plan covers vulnerable people, the fact is that millions will lose coverage.
Health care in the United States is more expensive because, unlike the systems in other countries, ours rests on the idea that profits and quality health care go hand in hand. As a result, government programs working with our existing structure of for-profit insurance companies can expand and improve coverage (like the Affordable Care Act) or offer lower insurance premiums (like the new Republican plan). But they can’t do both.
Supporters of the A.C.A., also known as Obamacare, talked a good game about “bending the cost curve,” but that was never a primary concern. The goal, largely achieved, was to expand access and to mandate coverage for essential health benefits and pre-existing conditions.
In contrast, the thrust of the Republican bill is to lower the cost of insurance by removing the guarantees of the A.C.A. States would be able to exempt any of the essential health benefits from insurance mandates, and they would also be allowed to exclude patients with pre-existing conditions. Millions are likely to lose their health insurance, but the young and generally healthy would pay much lower premiums.
In short, the two plans are not different takes on the same problem. They are different takes on different problems.
And the two problems are not equal concerns. Yes, the price of insurance is an issue — though a properly designed plan will at least move most of those costs off individuals and small businesses and onto the government’s shoulders.