By Jane M. Orient, M.D.
Senator John McCain of Arizona sequentially played the role of superhero, villainous traitor (to Republicans), and savior (to ObamaCare) as the McConnell “skinny repeal” lost by one vote—his.
First, he dropped in for the crucial vote on bringing the issue to the Senate floor, to a thunderous standing ovation, days after brain surgery (not “eye surgery,” as it was repeatedly billed by the press that covers “healthcare” matters). This is not his first such performance—he interrupted his 2008 presidential campaign to vote for TARP, the financial system bailout.
Once repeal itself was up for a vote, McCain ostentatiously cast the decisive “nay,” in a stunning violation of the vehement promises made during his Senatorial campaign. Somebody had to do it, since a lot of the Republicans really didn’t want to kill a cash cow for their state or donors. McCain is at the start of his term and has less to lose.
Then he made a speech that former senator Joe Lieberman said was “one of his finest hours.” McCain called for a “return to the bipartisan cooperation that can lead to real legislative accomplishments.”
“Bipartisan” is not the same thing as wise or good, and bipartisan mistakes are even harder to get rid of. But why the stark party-line divide here? Why did no Democrats offer any suggestions? Are they interested in helping their constituents, or just in obstructing Republicans? Do they believe the Affordable Care Act, Obama’s precious legacy, is functioning perfectly?
Hardly. Everybody seems to agree that the insurance “market” needs “stabilizing.” That means it needs more taxpayer dollars to bail it out. And if there aren’t enough votes to appropriate the money for cost-sharing subsidies properly, ACA partisans want the illegal funding begun by Obama and being paid month-to-month by Trump to continue. The lawsuit against this brought by the House of Representatives is sitting in the D.C. Court of Appeals, which just agreed to allow 18 attorneys general (17 states plus D.C.) to intervene on the side of lawlessness.
And why do insurers need the money? It’s because ACA allows them to offer only unaffordable, money-losing products. Premiums must escalate to the point that nobody can pay them without huge taxpayer subsidies. So why no bipartisan amendments to ACA’s price controls and larded-up “essential” benefits? Why not an amendment to legalize a genuine market for real insurance? The Democrats ought to have to explain why they object to actuarially fair premiums for low-risk persons, or why they insist on adding third-party overhead to routine costs that should be paid out of pocket. If the object is to help a few people with known high costs (“pre-existings”), why do they have to wreck the insurance market for the 95% who could get a policy they liked?
Why don’t any Democrats speak up for repealing mandates? Why do they insist on punishing people for not buying an overpriced product they don’t want? Do politicians really believe that coverage is the same as care? And do they swallow the Congressional Budget Office (CBO) fictions: (1) that the individual mandate has worked and (2) that choosing not to buy something is the same as “losing” it? Are they all that lacking in understanding and judgment, or is it all partisan politics?
Or do they understand perfectly well that ACA is a wealth transfer mechanism from those who receive or provide brain surgery or other actual care to Congress’s real constituents, the money-changers? Consider, for example, the really big cash sinkhole: Medicaid. A lot of people wouldn’t bother to enroll in Medicaid, even though it is free, if they didn’t have to pay to avoid it (the individual mandate). Then the states and managed-care contractors would lose the constant flow of federal dollars for patients who are not getting care.
And what about the neediest patients, say an American Charlie Gard? Medicaid doesn’t cover experimental treatments. Would Charlie’s parents be allowed to raise money and pay privately?
The question of whether Medicaid recipients are restricted to care available within the system comes up frequently. In Sen. McCain’s home state of Arizona, we are trying to get a clear answer.
Why do we need to ask the question? Because when government pays, your medical care is a partisan political issue.
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. Dr. Orient is the 2017 recipient of The Edward Annis award for medical leadership.