When it comes to health care policy there are two kinds of people: those who know that health care is not the same as health insurance, and those who confuse the two. Health care is actually what people want… the actual access to someone who’s going to take care of their health needs, whatever those needs might be, while the health insurance is a system that has been created to divide that cost among the most number of people possible.
But insurance is not care. And this was the nasty piece of dishonesty, the massive lie at the center of the Affordable Care Act. It was a lie predicated on a series of meaningless metrics, and the artificial alities created by the public policies that sprung up in its wake. Because of this massive lie, any meaningful health care reform, reform that actually increases the amount of care out there, makes availability much more universal, and actually drives down the cost of that care, must start with the repeal of the Affordable Care Act.
Repeal is only the start! Because the ACA was so massive, and the policies created by the systemic lies upon which it was based have grown so pernicious, that repeal is only the first step in truly reforming health care in America, and the reforms created in the American Health Care Act are themselves only the next immediate steps that must be taken in order to achieve that comprehensive reform.
Let’s start with this lie: it is essentially meaningless to frame any discussion of health care in America over the number of people who have health insurance. This is because without the doctors, nurses, Physician’s assistants, and other professionals who actually provide this care, if we were to ensure everyone in America, and we did not have enough of these professionals to provide that care, that insurance wouldn’t be worth the paper it is printed upon.
We do not. And that number is only going to get worse. In fact, because the Affordable Care Act didn’t address any of the underlying conditions that created to this gab, and instead exacerbated nearly all of those conditions, the ACA made matters far worse.
To compound the dishonesty, the “successes” of the ACA were similarly illusory… when you mandate that people buy a product, suffer penalties when they do not, and massively subsidize the purchase of that product for people who can’t afford it (and can’t afford not to buy it), it’s not a successful policy when the numbers of people who buy that product goes up—since you haven’t solved the underlying problem.
Which is why criticisms from the left that millions might lose their insurance due to the AHCA—in fact, any criticisms of the number of insureds under the AHCA are completely and utterly misguided. They are a debate without any real meaning. What is true about the AHCA are three basic concepts (among many others)… that it repeals Obamacare, that it provides one of the most-massive tax cuts in US history, and that, in doing both, sets the stage for real reform of health care in the United States.
And the AHCA materially repeals Obamacare! As Americans for Tax Reform notes, it abolishes 14 taxes that “siphon off nearly one trillion dollars” from the American economy each decade! It phases out Medicaid expansion, implements block grant programs for states, and eliminates open-ended Obamacare subsidies. Most importantly, it repeals the individual mandate… an affront to individual rights while at the same time being a massive exercise in crony capitalism.
Let’s be clear here: real reform to health care cannot occur without the repeal of Obamacare happening first. Because the ACA mandates that every American be “insured” and because the ACA prescribes with great explication what constitutes that “insurance” and because those mandates reach deeply into the practice and provision of medical care, the ACA has to be scrapped (in large measure, if not completely) before any of the good things that happen in a free marketplace (or either insurance or care) take hold.
Given the constraints of congressional rules, the AHCA is necessarily limited in its scope—repealing the ACA, reforming tax rules, dealing with fiscal aspects. But the AHCA is not the end-all. Congress has another 18 months before the 2018 elections to pass new health-care oriented laws, in order to fix the other aspects of the problem and create more choices for America’s working families, and the Department of Health and Human Services can get to work on crafting reforms and recommendations that can actually do what needs to be done to make health care more affordable, and more available, to as many (if not all) Americans.
In the end, it is all going to come down to basic resource economics. If you want more people to have health care (ie, higher demand) and you want to push prices lower, then you have to increase the supply of that health care. Not health insurance, but health care. This means creating more doctors, more nurses, more physician’s assistants, and finding out why we are losing more of these professionals, and what the impediments are to creating more of them. It means greater competition in the provision of health care, which means a freer market in that health care. This means more free-market tools like health savings accounts (which the AHCA, rightfully, favors).
The AHCA isn’t perfect. But it is a massive step in the right direction, an essential step. If you want real free market health care reform, then supporting the AHCA is an imperative.
Andrew Langer is President of the Institute for Liberty and has been talking about free-market reforms to health care for more than a decade.
