Senator McCain’s surgery and his as-of-yet unknown date of return to the Senate; a BCRA(p) bill that must be passed under the FY17 budget resolution, using the reconciliation process (thus preserving a FY18 budget resolution/reconciliation process for tax reform); senators announcing they are no votes on the MTP for widely-varying reasons; and a squabbling Republican caucus that is being “enticed” by McConnell in any way possible have combined to create a perfect storm for the Resistance. Every delay enables us to make more calls and create more pressure, and every delay brings us closer to the end of FY17, the adoption of a FY18 budget resolution, and the resulting loss of the ability to use FY17 reconciliation for the repeal and replacement of the ACA. In the event you’re starting to feel the Resistance Burnout Blues, today I’m comparing and contrasting the Democratic and Republican platform planks related to healthcare. Because of the timeliness, detail, and complexity of the topic, I will be covering healthcare in two separate posts, today and on Thursday.
The Democratic platform addresses healthcare under the overall heading, Ensure the Health and Safety of All Americans; by contrast, the heading for the Republicans is Great American Families, Education, Healthcare, and Criminal Justice. This is the first clue that we’re going to see very different approaches, both in content and degree of detail. Healthcare does not get its own separate section in the Republican platform, probably in part because of their distinctive, individualistic philosophy as detailed in this statement of what they call “American values”:
We are the party of independent individuals and the institutions they create together — families, schools, congregations, neighborhoods — to advance their ideals and make real their dreams. Those institutions, standing between the citizen and the power of government, are the pillars of a free society. They create spaces where the power of government should not intrude. They allow Americans to work together to solve most of the problems facing their communities. They thus reduce the need for intervention by government in the form of more and bigger programs or a larger public workforce. They minimize decision-making by those who hold or are appointed to office. That is precisely why today’s progressives distrust and seek to control them — because this is more than a conflict of ideas. It is a struggle for power.
Our society is at a crossroads. For several generations, an expansive federal regime has marginalized and supplanted the institutions holding our society together. No wonder, then, that so much seems to be coming apart now. The question is whether we are going to reinvigorate the private sector institutions under citizen control or allow their continued erosion by the forces of centralized social planning. In that divide, the Republican Party stands with the people.
Democrats have no problem embracing the so-called “forces of centralized social planning.” They open with a proud reiteration of what has been accomplished and a summary of what is still to be achieved:
Democrats have been fighting to secure universal health care for the American people for generations, and we are proud to be the party that passed Medicare, Medicaid, and the Affordable Care Act (ACA). Being stronger together means finally achieving that goal. We are going to fight to make sure every American has access to quality, affordable health care. We will tackle the problems that remain in our health care system, including cracking down on runaway prescription drug prices and addressing mental health with the same seriousness that we treat physical health. We will fight Republican efforts to roll back the clock on women’s health and reproductive rights, and stand up for Planned Parenthood. And we will tackle the epidemics of substance abuse and gun violence, which each claim tens of thousands of lives every year.
Under the subheading Securing Universal Health Care, the Democratic platform states that “Democrats believe that health care is a right, not a privilege, and our health care system should put people before profits.” This statement of principle is followed with key details for securing that right:
Democrats will never falter in our generations-long fight to guarantee health care as a fundamental right for every American. As part of that guarantee, Americans should be able to access public coverage through a public option, and those over 55 should be able to opt in to Medicare. Democrats will empower the states, which are the true laboratories of democracy, to use innovation waivers under the ACA to develop unique locally tailored approaches to health coverage. This will include removing barriers to states which seek to experiment with plans to ensure universal health care to every person in their state.
The Republicans, on the other hand, return to their individual first-societal good second (if at all) philosophy with the subheading Restoring Patient Control and Preserving Quality in Healthcare. They sum up the evils of the ACA like this:
Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare. It weighs like the dead hand of the past upon American medicine. It imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions. It has driven up prices for all consumers. Their insurance premiums have dramatically increased while their deductibles have risen about eight times faster than wages in the last ten years. It drove up drug prices by levying a $27 billion tax on manufacturers and importers and, through mandated price cuts for drugs under Medicare and Medicaid, forced pharmaceutical companies to raise prices for everyone else. Its “silver plans,” the most common option on the government insurance exchanges, limit people’s access to their own doctor through narrow networks and restrict drug coverage, forcing many patients to pay for extremely costly medicines for their chronic diseases.
We agree with the four dissenting judges of the Supreme Court: “In our view, the entire Act before us is invalid in its entirety… It is time to repeal Obamacare and give America a much-needed tax cut.
Now that the Republicans have established how oppressed we all are by Obamacare, they suggest a “new” approach (the urge to annotate some of this stuff is strong, but I’ll restrain myself. All bolding is mine, because I said “restrain” not restrict):
…We must recover the traditional patient-physician relationship based on mutual trust, informed consent, and confidentiality. To simplify the system for both patients and providers, we will reduce mandates and enable insurers and providers of care to increase healthcare options and contain costs. Our goal is to ensure that all Americans have improved access to affordable, high-quality healthcare, including those struggling with mental illness.
We will return to the states their historic role of regulating local insurance markets, limit federal requirements on both private insurance and Medicaid, and call on state officials to reconsider the costly medical mandates, imposed under their own laws, that price millions of low-income families out of the insurance market. To guarantee first-rate care for the needy, we propose to block grant Medicaid and other payments and to assist all patients, including those with pre-existing conditions, to obtain coverage in a robust consumer market. Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.
To ensure vigorous competition in healthcare, and because cost-awareness is the best guard against over-utilization, we will promote price transparency so consumers can know the cost of treatments before they agree to them. We will empower individuals and small businesses to form purchasing pools in order to expand coverage to the uninsured. We believe that individuals with preexisting conditions who maintain continuous coverage should be protected from discrimination. We applaud the advance of technology in electronic medical records while affirming patient privacy and ownership of personal health information.
While I am deriding the Republicans for their complaints against the ACA, it’s only fair to point out that the Democratic platform recognizes, but also addresses, some of its failings:
For too many of us, health care costs are still too high, even for those with insurance. And medical debt is a problem for far too many working families, with one-quarter of Americans reporting that they or someone in their household had problems or an inability to pay medical bills in the past year. Democrats will also work to end surprise billing and other practices that lead to out-of-control medical debt that place an unconscionable economic strain on American households. We will repeal the excise tax on high-cost health insurance and find revenue to offset it because we need to contain the long-term growth of health care costs, but should not risk passing on too much of the burden to workers. Democrats will keep costs down by making premiums more affordable, reducing out-of-pocket expenses, and capping prescription drug costs. And we will fight against insurers trying to impose excessive premium increases.
…We will keep fighting until the ACA’s Medicaid expansion has been adopted in every state. Nineteen states have not yet expanded Medicaid. This means that millions of low-income Americans still lack health insurance and are not getting the care they need. Additionally, health care providers, clinics, hospitals, and taxpayers are footing a higher bill when people without insurance visit expensive emergency rooms.
Democrats believe your zip code or census tract should not be a predictor of your health, which is why we will make health equity a central part of our commitment to revitalizing communities left behind. Democrats believe that all health care services should be culturally and linguistically appropriate, and that neither fear nor immigration status should be barriers that impede health care access.
Now the Republicans did mention those “struggling with mental illness”…barely. So what do the Democrats say? They have an entire sub-heading called, Treating Mental Health, although they touch on mental health issues elsewhere. The general statement says:
We must treat mental health issues with the same care and seriousness that we treat issues of physical health, support a robust mental health workforce, and promote better integration of the behavioral and general health care systems. Recognizing that maintaining good mental health is critical to all people, including young people’s health and development, we will work with health professionals to ensure that all children have access to mental health care. We must also expand community-based treatment for substance abuse disorders and mental health conditions and fully enforce our parity law. And we should create a national initiative around suicide prevention across the lifespan—to move toward the HHS-promoted Zero Suicide commitment.
And while the Democrats have much more to say on the topic of Securing Reproductive Health, Rights, and Justice , for today, I’ll just include this:
…We believe unequivocally, like the majority of Americans, that every woman should have access to quality reproductive health care services, including safe and legal abortion—regardless of where she lives, how much money she makes, or how she is insured. We believe that reproductive health is core to women’s, men’s, and young people’s health and wellbeing. We will continue to stand up to Republican efforts to defund Planned Parenthood health centers, which provide critical health services to millions of people. We will continue to oppose—and seek to overturn—federal and state laws and policies that impede a woman’s access to abortion, including by repealing the Hyde Amendment. We condemn and will combat any acts of violence, harassment, and intimidation of reproductive health providers, patients, and staff. We will defend the ACA, which extends affordable preventive health care to women, including nocost contraception, and prohibits discrimination in health care based on gender.
I think that’s enough for today; I’ll conclude with the healthcare planks in my next post on Thursday.
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