Frist Principles

Congress begins its 114th session today and GOP leaders have promised to begin governing right away. One of the topics mentioned is changes to the Affordable Care Act. Some Republicans want it repealed outright and others while supportive of repeal favor nibbling at the edges, like changing the requirement for employer supplied health insurance from 30 hours of work to 40. So what is the principle they are working from?

Maybe you have heard about the tremendous burden ACA has put on employers, especially small business owners. Anything the GOP can do to lighten the load of these entrepreneurs, the better American makes out.That doesn’t sound like a “first principle” to me. Hmmm.

On the other hand, saddling small businesses (or any business for that matter) with extra costs doesn’t seem like a robust idea. So are Republicans on to a good idea?

So what are the first principles Republicans (or anyone for that matter) has around healthcare?

Does the GOP believe that everyone (in the world’s wealthiest country) should have access to basic healthcare in a dignified and affordable manner? Or do Republicans subscribe to the idea that everyone is entitled to the best healthcare they can afford? So, if you work harder, save wiser, you can afford the best healthcare America has to offer. If not, you had better change your ways and become more productive.

Please do not misinterpret these thoughts to suggest Democrats have more humane or practical “first principles”. The Affordable Care Act was a political compromise of the first order and is deeply flawed. Its redeeming characteristics are providing broader coverage (more people eligible and far fewer denied coverage), and the seeds for changing medical practices towards greater efficiency (and lower cost).

One would not go too far astray in thinking that the Democrats’ first principle might have been “everyone is entitled to basic healthcare and we will worry about paying for it later (after you have voted for Dems)”. Hmmm.

The most mystifying aspect of the healthcare debate is the wealth of positive health care experience in over 20 modern industrialized nations (not to mention Cuba) where healthcare outcomes are as good or superior to the US, AND at cost levels one half or less that the US spend. Why wouldn’t both political parties be jockeying for ownership of the idea to adopt healthcare models such as in France, Germany, or Japan?

Congress will make great pronouncements about ACA and will point out certain aspects as unnecessary and unjustified. My guess is that many, if not all the Republican examples, ought to be changed (providing the GOP finds alternate means to fund ACA).

The GOP’s real intentions will flow from what they propose as “fixes”. For example, reducing the number of employer who supply healthcare plans will put pressure upon “exchanges” to pick up those left uninsured. Read more government subsidies. Will the GOP raise taxes to cover? The same outcome will follow any attempt to eliminate the individual mandate.

Here’s the surprise. In a world class healthcare system, there would be no discussion of individual mandates or employer required healthcare policies, everyone would be automatically insured for basic coverage.

The first principle involved in these programs is that everyone has a right to basic healthcare coverage and has a responsibility to pay their share of the national cost burden. In addition, the prices for all healthcare services (doctors, hospitals, drugs, and all associated equipment and supplies) are negotiated.

The last six years have demonstrated that neither party is willing to touch the first principle found around the world and provide all Americans with healthcare as good as we have now at half the cost. Good luck 114th.  Hmmm.

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