This week, President-elect Donald Trump and congressional Republicans began to dismantle Obamacare, and here are the details of their replacement plan:—— —- —- —- - —— —- —— —- - —-—- — —— —- —— —- —- —- — — - - -- —— —- —- —— —- —- —- - —— —-—— —- - —- —- — —— —- - —- —- — -—- —- — —— —- - —- —- — - —- —-That captures the nonexistent Republican plan to replace Obamacare. They’re telling Americans who feel trapped by health care problems: “Jump! Maybe we’ll catch you.”This G.O.P. fraud is called “repeal and delay.” That means repealing the Affordable Care Act, effective in a few years without specifying what will replace it.
If the Republicans ran a home renovationbusiness, they would start tearing downyour roof this month and promise to returnin 2019 with some options for a new one —if you survived.
And survival will be a real issue. Thebottom line of the G.O.P. approach is thatmillions of Americans will lose insurance,and thousands more will die unnecessarilyeach year because of lack of care.
The paradox of Obamacare is that it isboth unpopular and saves lives. Preliminaryresearch suggests that it has already begunsaving lives, but it’s too early to have robustdata on the improvements to life expectancyamong the additional 20 million peoplewho have gained insurance. It is notablethat an Urban Institute study found that onthe eve of Obamacare’s start, lack of healthinsurance was killing one American every24 minutes.
One careful study found thatthe Republican health care plan inMassachusetts, which was the model forObamacare, noticeably lowered mortalityrates. For every additional 830 adultscovered by insurance, one death wasprevented each year.
The American College of Physicianswarned this week that the G.O.P. coursecould result in seven million Americanslosing their health insurance this yearalone, by causing parts of the insurancemarket to implode. Back-of-envelopecalculations suggest that the upshot wouldbe an additional 8,400 Americans dyingannually.
How can insurance make such adifference?I’ve written about my college roommateScott Androes, a fellow farm boy fromOregon, who switched careers in 2003 anddidn’t buy health insurance on the individualmarket because it was so expensive. Then in2011 he had trouble urinating and didn’t seea doctor because of the cost.
By 2012 he had blood in his urine andfinally was scared enough that he soughtmedical help. He had waited too long: Hehad stage IV prostate cancer. “I blew it,”Scott told me. “I feel like a damned fool.”He showed immense courage in agreeingto tell his story — despite concern that hislegacy would be an article highlightinghis foolishness — because he wantedpeople to understand the human cost of alack of universal insurance. He died soonafterward.
That’s the system that the Republicansare trying to take us back to.
Americans spend two or three times asmuch on health care as a share of G.D.P.
as other industrialized countries but getworse outcomes. American children are75 percent more likely to die in the firstfive years of life than British or Germanchildren, according to World Bank data,and American women are twice as likely todie in pregnancy as Canadian women. Thereasons have to do partly with Americanpoverty, and partly with the high number ofuninsured.
Trump would have you believe that hewill keep the popular parts of Obamacare,such as the ban on discriminating againstpre-existing conditions, while eliminatingunpopular parts like the mandate. That’simpossible: The good and bad depend oneach other.
The Trump approach would be liketrying to amputate a dog’s rear end so youwouldn’t have to clean up its messes. It justdoesn’t work that way.
A full repeal of Obamacare would alsoworsen the deficit. The CongressionalBudget Office said in 2015 that “repealingthe A.C.A. would increase federal budgetdeficits by $137 billion over the 2016-2025 period.” That’s more than $1,000 perAmerican household.
Yes, health policy makes eyes glaze over.
But focus on these two points: By broadagreement, the number of people insuredwill drop if Republicans “repeal and delay,”and more uninsured Americans means moreAmericans dying. That’s why the AmericanCollege of Physicians, the AmericanMedical Association and even conservativehealth care analysts have warned Congressnot to repeal Obamacare without stipulatingwhat comes next.
Republicans spent $7 million investigatingthe deaths of four Americans in Benghaziand ultimately found no evidence of highlevelwrongdoing. Now they are rushingtoward a scam that may cost thousands ofAmerican lives every year.
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NICHOLAS D. KRISTOF>
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