What are you really thinking?

I admit it, I’m a liberal Democrat and quite partisan.  I am for progressive taxation where the wealthy pay high amounts through steep upper income brackets.  I support strong regulation on corporations to protect consumers from inherent greed that those institutions enable.  I also believe that quality health care is a fundamental right for all and not a privilege for those who have the means to afford it.

I also realize that not everybody sees the world as I do.  Yes, I will criticize,challenge and even attack those who have different political views that I, but I try to apply such criticism to a person’s judgment and not their motives or values.  Today, I confess that I am struggling with this in light of the passage of the Republican bill to repeal the Affordable Care Act.  I realize that supporters may believe it will reduce premiums, although this really depend who you are.  There are even people who believe that the tax cuts in the bill are great, although I don’t know a single person who will personally benefit from them.  For those of you that think those are good aspects, I think you have assessed and judged this bill poorly.  That alone does not cause me to question your values or ethics, but it doesn’t explain to me why you support something that will actually kill people.  Many of my friends agree with me on this, but this blog post isn’t really directed to them.  I hope supporters of the Republican bill read my analysis supporting my conclusion and responds to help me understand why a good person can support something that results in people dying.

What the bill does

I’m not interested in an extended debate of the independent projections of this bill, because simple disagreement of forecasts does not speak to the values of humanity that are at question here.  If you think the facts and figures below are wrong or a result of cooking the books, then I simply conclude that you have been fooled by the political spin of the Republicans around this bill and I would criticize your lack of good judgment in assessing the information that is publicly available.  Below, are some independent assessments of Republican bill, or at least the previous version because the House passed it without an updated scoring from the Congressional Budget Office:

Congressional Budget Office

  • Reduce federal budget deficits by $337 over 10 years, compared to current law
  • In 2018 (next year) 14 million more people would be uninsured
  • That number would rise to 20 million in 2020 and 24 million in 2026
  • In the non-group market, premiums rise steeply compared to current law in the first couple years, but settle out about 10% lower in 2026.

There are winners and losers in this bill due to the replacement of need based subsidies with age based tax credits as well as the elimination of penalties for those who opt to not buy insurance, but the numbers above are the best estimates the CBO can make right now.

It’s a mixed bag.  Premiums may be a little lower by 2026, but not the huge reduction that Republicans are promising.  After eliminating the taxes, cutting the subsidies and block granting Medicaid, it does save some money, but approximately $30 billion a year is a pretty small amount compared to our $3 to $4 trillion annual budget.  The affordable care act was designed to expand coverage to and significantly reduce the number of uninsured Americans and it did that.  According to Gallup, the percentage of Americans without health insurance peaked in 2013 at 18% and today is about 11%.  This bill largely reverses those gains.  Projecting these estimates for 10 years undoubtedly contains some error, but the overall conclusion that tens of millions will lose coverage is a pretty sure bet.

People will die

When people lose their health insurance, they lose access to basic preventative care that a good comprehensive policy covers.  This results in health problems going undetected.  It also means that people may choose to avoid seeking care and hope that symptoms they are noticing are not something serious, because they fear not being able to pay the bill.  If you have a life threatening condition and let seeing a doctor be a financial decision, by the time you do it may be too late.

There is evidence to link being uninsured to mortality.  A study by the Harvard Medical School found that 45,000 death each year can be attributed to a lack of insurance.  The Institute of Medicine concluded 18,000 deaths per year.  An Urban Institute study put the number at 22,000.  The Journal of General Internal Medicine found that the uninsured had a 26% higher mortality rate.  While there is a lot of variability in these studies, they all conclude that if you are uninsured, your chance of dying is higher than if you have health insurance.

My conundrum

I’m really trying to believe that people I know who support this bill, especially those who are informed with the above information and actually accept the projected impacts of the bill, are good people who truly care about their fellow brothers and sisters in Christ.  I’m struggling to do that because there is a human cost for any perceived or real benefits of this bill.  Tens of millions of Americans will lose their insurance and some of those people will die.  How many dead people is an acceptable cost for saving about $30 billion in our budget deficit each year?  How many dead people are the tax savings for the wealthy and corporations worth?  I sincerely hope I get some answers that I have not considered.  I may not agree with you, but I’m asking you to help restore my belief in the good nature of humanity.



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