What The Election Means To Your Medical Care

by Jane M. Orient, M.D.

People are marching with “Health Care Voter”  signs, and this is generally believed to be one of the most important issues in the 2018 midterm elections. Republicans who got elected on the promise to repeal ObamaCare, and reneged, may now get unelected. Voters who supported them are dissatisfied, and Democrats demand still more government involvement in medicine.

On Twitter, #HealthCareVoter posts warned that the confirmation of Brett Kavanaugh to the U.S. Supreme Court would “rip health care away from people with pre-existing conditions.” This illustrates several profound misunderstandings.

By “health care,” most seem to mean health “insurance”—usually a prepaid health plan, which is not at all the same as medical care. The Supreme Court already decided that it is unconstitutional under the Commerce Clause to force people to buy a commercial product. Remember stare decisis? Would it be ok to overturn the ACA decision, just not Roe v. Wade?

The Affordable Care Act (ACA or ObamaCare) ripped away Americans’ freedom to refuse to buy an unaffordable or objectionable insurance product, punishing such refusal by a “tax.” Contrary to Obama’s promises, it also ripped away insurance plans that Americans had relied on for years. Some people had three or more policies cancelled, one after the other, forcing them into plans with less coverage and a much higher price. Many such plans ripped away actual medical care by excluding physicians or facilities that provided the needed specialized treatment.

What happened with pre-existings before ACA? Most people were unaffected because they had employer-sponsored coverage. Only the seven percent of Americans in the individual market faced underwriting for pre-existings. If they were insured before they became ill, the insurance contract generally prohibited dropping them from coverage or stopping treatment. Prudent people bought insurance at low cost when they were healthy and maintained continuous coverage. Those who didn’t often had access to a state high-risk pool—before ObamaCare did away with them. Almost all got medical care—either they paid for it, or the doctor didn’t get paid.

ObamaCare removed the incentive to buy insurance before one “needed” it, since one could not be declined or charged more. The individual mandate did not prevent this system-gaming, the equivalent of buying fire insurance when your house is on fire.

Now Congress has reduced the ObamaCare tax to $0, and the Trump Administration has liberalized rules on short-term, limited-duration policies, allowing Americans to choose affordable policies that cover trauma and serious illness, while they buy routine, expected care the old-fashioned way, without the supervision of a health plan intent on saving its money. ACA lovers want to rip away this option, so that heathy Americans must be greatly overcharged or else forgo insurance.

If the angry Health Care Voters who are agitating in the streets win, most ordinary Americans lose. Not seven percent, but 100 percent of Americans could lose their right to control their medical care—and the dollars they earn.

Medical decisions will be politically determined. Those who want free services that enable their lifestyle (contraception, abortion, treatment for sexually transmitted diseases) will be chanting in the streets. Old people with disabling hip pain, babies with heart defects, the girl with a ruptured appendix waiting in an endless line will suffer and die. Politically favored diseases or patients will get preferential treatment. Skilled physicians will be scarce. Most care will be rendered by minimally trained clinicians, relying on computerized “guidelines.” Writers of the guidelines generally have many lucrative connections with pharmaceutical companies and other corporate monoliths who thrive by getting favors from Congress.

There will be winners and losers, picked by an ever-growing bureaucracy. Voters who aren’t chanting slogans amplified by media will have little influence. Congress will continue to exercise its tax-and-spend power as directed by powerful moneyed interests, but it has delegated most of its power to administrative agencies. Ruthless health plans will prosper as they set up high barriers to care, while independent physicians are squeezed out.

In the history of the world, the path to a centrally planned, restrictive collectivist system has generally been one-way. The system has many well-paid retainers, and millions of impoverished dependents incapable of seeking a way out.

Americans need to vote for freedom, competitive enterprises, and less not more government intrusion in their decisions. They need to be sure their candidate can pass the Single Payer IQ Test™, after they read the Study Guide themselves.