The purpose of America’s government, as penned
by the Founding Fathers, is to “establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty.” Republicans have proposed a litany
of “repeal and replace” healthcare bills that do not achieve any of these bipartisan virtues. The bills have failed to serve the interests of Americans — this was their fundamental shortcoming. In spite of a Republican majority in both houses of Congress, the bills have, appropriately, not succeeded in gaining the votes to be legislated.
“Repeal and replace” is a political solution, in search of a policy problem. We’ve seen improving the healthcare of Americans play second fiddle to the rhetoric and political interests of Congressional Republicans. Hard working Americans repeatedly berated their Republican representatives at town halls across the country. The message delivered at these town halls was clear — Americans cannot truly be free until they have the healthcare they need.
In response, Trump has recently flagged two options: in the short term, an Executive Order that looks set to decimate healthcare markets, leaving millions of Americans worse off; and a “great bipartisan health care bill,” with discussions between Trump and Democrats already underway.
Although an Executive Order looks increasingly likely, there is reason to also hope for a bipartisan solution. In September 2015, Trump explained, “Everybody's got to be covered. This is an un-Republican thing for me to say … I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now … the government's gonna pay for it.” During Trump’s first address to Congress in February 2017, he went further demanding “reforms that expand choice, increase access, lower costs and, at the same time, provide better health care.”
These are promising ambitions that address real problems. Researchers at the bipartisan New York based Commonwealth Fund recently compared healthcare performance across 11 high-incomes countries including Canada, Australia, and the United Kingdom. The U.S. ranks last. This is the harsh reality facing Americans.
The Commonwealth Fund’s report highlights five problems that must be addressed if bipartisan healthcare policy is to succeed. Regardless of the policy that is ultimately developed, shared agreement on the problem, anchored in improving American’s lives, is fundamental.
First, Americans spend substantially more on healthcare than other countries — 16.6 percent of GDP and three times the OECD average. Switzerland comes in a distant second at 11.4 percent. Americans don’t use more healthcare; American healthcare is more expensive.
Despite spending more on health care, Americans have the worst health care outcomes. Sadly, the statistic that the U.S. ranks highly on is the number of preventable deaths per year. With timely access to healthcare, over 13 percent of deaths in the U.S. could be prevented. Shockingly, if healthcare in America was akin to that experienced by Australians, over 150,000 American lives would be saved each year.
Americans lack access to primary healthcare. The U.S. is the only high-income country studied that does not have universal healthcare coverage. As a result, low cost preventative interventions such as routine screens are harder to come by, leading to increased prevalence of costly chronic conditions including heart disease and diabetes. A fragmented and convoluted system of insurance also leads to America ranking 10th of 11 on administrative efficiency. The American public understand there is a better way. Over 60 percent believe the “federal government is responsible for ensuring health care for all.”
Relative to other countries, Americans pay higher insurance deductibles and out of pocket expenses. Despite more than 20 million additional Americans gaining insurance coverage in recent years, high deductibles mean that coverage is rendered useless in some cases. Trump must avoid a simpleton policy response that engenders a mass exodus of healthier Americans from insurance markets. Those left behind, particularly older middle-class Americans often with pre-existing conditions, will face higher premiums or may be locked out of insurance markets all together.
Finally, the U.S. has the most unequal healthcare system. Due to exorbitant costs, lower income Americans skip doctors visits, forego treatments, and do not fill prescriptions for life saving medications such as cholesterol drugs and asthma medication. For the first time in decades, mid-life mortality for less educated Americans is rapidly increasing. America cannot be the land of opportunity when basic needs are going unmet.
There is a glimmer of hope for bipartisan progress on health care that serves the interests of Americans. With midterms only 13 months away, the clock is ticking for Trump and the Republicans. If striking big deals really is, as Trump claims, his “art form” then now is his time. Were he and his Republican colleagues to fall short, Americans will do as the Founding Fathers instructed — “whenever any Form of Government becomes destructive … it is the Right of the People to alter or abolish it, and to institute new Government.”
Matt Tyler is an economist who works to improve government effectiveness with a particular focus on social services. Tyler is a former management consultant, where he supported executives in developing and implementing strategy across financial services, telecommunications, manufacturing, postal services, and retail. He worked as an economist for Australia’s foreign service and as a policy adviser to the Federal Australian Labor Party on economic and social policy. He has also worked for Third Sector Capital Partners where he assisted with the construction of two Social Impact Bonds in Salt Lake City. He is currently completing a Master of Public Policy at Harvard’s Kennedy School of Government. He tweets as @matt_b_tyler. To read more of his reports — Click Here Now.
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