The Republican reckoning on health care: Jill Lawrence

Ronald Reagan wanted to shrink the government and Bill Clinton said the era of big government was over. But their talk was premature. There was still one great task for the world’s wealthiest, most powerful nation to accomplish, and that was to make sure all Americans could get health care.

The Affordable Care Act has put us closer to that goal than we’ve ever been, yet President Trump and many in the Republican Party appear determined to reverse these gains. Why? It sure seems like it's because they’re wedded to ideological purity, the fantasy of a skeletal government, and a cruel political tactic (rip out “Obamacare” root and branch) that has outlived its purpose.

Sure, it was fun to win power all over Washington and the country by bludgeoning Barack Obama and his party. But the spotlight on the victims of Obamacare, people forced to change plans and those in some states whose insurance rates rose to unaffordable heights, is now shifting onto the victims of repeal — those who without the law could die, go bankrupt, or lose treatments that allow them to hold jobs, attend school, break an addiction, keep a grip on sanity.

Conservatives often complain about how hard it is to shrink or scrap a benefit that the rank and file are already enjoying. It’s especially difficult when that “benefit” is a necessity that should never be contingent on good luck, good health, lots of money or an employer plan. But they intend to try, starting with a House repeal vote as early as Thursday, exactly seven years after President Obama signed the historic health overhaul into law.

If the repeal forces needed any reminder of the need that led to the law in the first place, they received it this year with the rush to get insurance — more than 12 million people signed up even as Trump and the GOP Congress vowed to kill what they have variously libeled as a failed, collapsing, imploding, nightmarish disaster — and in the negative reaction they’re absorbing over the news that their proposed substitute could leave twice that many people without insurance by 2026.

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Nor are the politicians with pitchforks doing very well at convincing America that it matters to them. If you want voters to think you care, don’t refer to expanded health insurance coverage as a “beauty contest” or suggest people could afford policies if they’d stop wasting money on cellphones. Don’t assume that the poor “just don’t want health care,” that they don’t work, or that they’re not your voters anyway. Don’t forget that a majority of adults with Medicaid coverage work, and that even more live in working families. Or that Medicaid covered 51% of long-term care costs for the elderly and disabled in 2013.

And for those who say Medicaid is so bad it’s worse than nothing, talk to a few people who now have it, or read about them. They’re finally getting the respect, treatments, medications and access to specialists that the rest of us take for granted.

House Speaker Paul Ryan is in the forefront of promising a new era of health care "freedom ... to buy what you want to fit what you need" under the Republican bill. But as he no doubt knows, freedom of choice is not how insurance works. You can’t know what you will need or when, and that’s exactly the point.

Furthermore, one person’s freedom is another’s burden: the burden to pay higher premiums or hospital fees or taxes to finance the care other people didn’t think they’d need when they went uncovered or exercised the choice Ryan gave them to buy those bare-bones policies.

The freedom he envisions is the freedom to be sick and uninsured, or sick and underinsured. It’s the freedom to go bankrupt, to rely on the charity of hospitals that won't turn you away and on the responsible behavior of other taxpayers and policyholders, who will end up bailing you out.

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You could, of course, let people pick and choose what they want and think they need. You could dramatically change the required benefits package so men or senior citizens could choose not to pay for maternity care. But where does that end? Can young people pass up dementia benefits or hip replacements? Can women opt out of paying for testicular and prostate cancer? Can men say no to breast cancer? And about that maternity care — should women of child-bearing age really have to shoulder that burden alone? That baby has a father and grandparents.

And by the way, everyone with insurance through work is already paying for all kinds of services they don't use but their colleagues do. It's called an insurance pool.

You don't have to be a conservative to see that the health law needs changes to stabilize insurance markets and consumer costs, and it would be wondrous (not to mention smart and practical politics) to behold the two parties working together to fix this landmark law. But nor should you have to be a bleeding-heart humanitarian to see that it’s in our national economic interest to have a healthy population that doesn’t live in fear of illness, death, insurance cutoffs or medical bankruptcy.

There's a reason six in 10 Americans say the government should make sure people have health coverage. There’s a reason Cole Porter wrote these lyrics in 1940: “I still got my health, so what do I care.”

There’s no need more universal or fundamental.

Jill Lawrence is the commentary editor of USA TODAY and author of the new bookThe Art of the Political Deal: How Congress Beat the Odds and Broke Through Gridlock. Follow her on Twitter: @JillDLawrence

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