Health reform: Pragmatism or radicalism?

The Republican Party, my party, is having a tough time getting rid of the Affordable Care Act (Obamacare) as it promised.


Desperate for a legislative win, President Trump successfully strong-armed House moderates to pass the American Health Care Act (Trumpcare), even though the bill is contrary to many of his campaign pledges. However, with 24 million losing insurance, the bill has no chance of making it through the Senate as it now stands.

Even though the ACA has major problems, the fact is that it has caused more than 20 million Americans to have affordable insurance coverage via Medicaid expansion and substantial subsidies given to 85 percent of exchange enrollees.


I am a capitalist. I made my money from scratch under the free enterprise system, primarily in health care. I am also a social progressive and a pragmatic fiscal conservative, as was proved by my record as an elected official. I am a lot of things.

Americans are also a lot of things. Many conservative elected officials know that, down deep, Americans are secret socialists. They actually like the social services provided by government, even if they complain. They just don’t like these programs philosophically, even when they and their families are on them (as many of my GOP-voting friends currently are).

Why? Because of the myth of individualism in America, the false ideal that each of us should be John Wayne stoically making our way through a brutal world and succeeding on our own against great odds. But, that is what it is: a myth.

Surveys show that when programs such as Medicare, Medicaid, and CHIPS (and even the ACA) are actually enacted, they become popular. They are almost impossible to get rid of for two reasons: they serve a primary societal need (affordable health care); and a vocal voting constituency is receiving the benefit.


So, what does the right-wing GOP leadership do to address the issue of abolishing these services? Clearly, conservative strategy is to use pleasant language to cover up the truth: They just don’t want people to get the services they need because they dislike domestic spending on these entitlement services which they consider (wrongly) “welfare.”

When Health and Human Services Secretary Tom Price (a primary author of the AHCA) talks about “patient-centered” health care, what he is really saying is that he wants to go back to a system in which patients have to fend for themselves. As a congressman, his own draconian reform bill to abolish the ACA, kicking many millions off health insurance, proved that point. For Price, “patient-centered” equals throwing uninsured patients to the wolves.

Fortunately, the public seems to have awakened to this fact. Polls have changed dramatically over the past few months. Now, the majority of the public wants the GOP Congress to go on to something else, such as tax reduction.

Instead, Congress and Trump continue to plough away in a poisoned, barren field. There was no support for their original reform plan (AHCA). With 24 million falling back into the ranks of the uninsured and $600 million in tax breaks to the wealthy, what did they expect?


By trying to appeal to the radical right-wing Freedom Caucus, they have made the original bill much worse. The latest iteration does not require states to cover pre-existing conditions. It also guts the requirement to have a decent package of services covered by the plan, making the actual insurance worthless for many conditions. I pity congressmen in swing districts who try to justify this catastrophe to their constituents.

My advice is go on to other things or, much better, do the unthinkable. Work with the Democrats to identify fixable problems with the ACA, and then get their votes on a bipartisan reform measure. A compromise approach will work. Radicalism in the name of party unity will not.


The writer was the first director of health planning for the state of Georgia and retired as a senior vice president with a national health care firm.



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