Debunking Republican and Democratic health care myths

Debunking Republican Health Care Myths

By The Editorial Board
The New York Times, April 19, 2016

“Disaster.” “Incredible economic burden.” “The biggest job-killer in this country.”

Central to the presidential campaigns of Donald Trump and Ted Cruz has been the claim that the Affordable Care Act has been a complete failure, and that the only way to save the country from this scourge is to replace it with something they design.

It’s worth examining the big myths they are peddling about the Affordable Care Act and also their ill-conceived plans of what might replace it.

Millions of people have lost their insurance: In January, Mr. Cruz claimed that “millions of Americans” had lost their health insurance because of the health reform law. He even claimed to be one of them, saying “our health care got canceled” because Blue Cross Blue Shield left the individual market in Texas.

Insurers did stop offering some plans after the law took effect, including those that didn’t provide required benefits like maternity care or that charged higher premiums to older or sicker people. But people with those plans had the opportunity to sign up for others. And over all, the law has drastically reduced the number of Americans who lack health insurance. According to the Census Bureau, the number of uninsured Americans dropped by 10 million between 2010, when the law passed, and 2014. While critics said employers might stop offering health insurance because of the law, three million people actually gained coverage through their employers between 2010 and 2014.

Incidentally, Mr. Cruz never lost his health insurance. Blue Cross Blue Shield did cancel his particular plan, but it automatically moved him and his family to a new one. A Cruz spokeswoman said the senator had been misinformed by his insurance broker.

Millions of people have lost their jobs: Mr. Cruz has called the Affordable Care Act “the biggest job-killer in this country” and said “millions of Americans have lost their jobs, have been forced into part-time work” because of it. This is false. The unemployment rate has fallen since the law took effect, PolitiFact notes, as has the number of people working part time when they would rather work full time. A 2015 study using data from the Current Population Survey found that the law “had virtually no adverse effect on labor force participation, employment or usual hours worked per week through 2014.”

Reduce costs by weakening state regulations: Mr. Trump frequently talks about his plan to “get rid of the lines around the states” to foster competition among insurance companies. Customers in states where insurance is heavily regulated, the thinking goes, would be able to save money if they could purchase coverage from insurers based in states with fewer rules. Mr. Cruz, too, supports allowing people to buy insurance across state borders — it’s one of the few proposals he’s offered for replacing the health law if it is repealed.

But the biggest obstacle stopping insurers from setting up in more states is not regulation; it’s the difficulty of establishing a network of providers in a new market. And such a structure would destroy the longstanding ability of states to regulate health insurance for their populations. Some states, for instance, require coverage for infertility treatment and others have chosen not to. Allowing cross-border plans would encourage insurers to base themselves in low-regulation states, and the result might be a proliferation of poor-quality plans.

The Affordable Care Act is not perfect. Premiums for plans on the exchanges rose between 2015 and 2016 and are likely to rise again next year. A few insurers have left the exchange market, raising concerns in some quarters that more companies might follow.

But the law has helped millions of Americans, especially low-wage workers like cashiers, cooks and waiters who previously struggled to pay for coverage. In inventing problems that don’t exist and proposing solutions that won’t help, Donald Trump and Ted Cruz show that they don’t care about helping Americans get health care, which has never been their interest. They want to trash the Affordable Care Act, and they’re willing to mislead the public any way they can.

Reader Comments - NYT Picks:

By Don McCanne, M.D.
San Juan Capistrano, CA

How about debunking the Democratic ACA myths?

ACA is universal, except for 29 million left out.

ACA is affordable, except for the premiums and deductibles.

ACA provides choice, within narrower networks.

ACA replaces quantity with quality, except we haven't figured out how to do that.

ACA doesn't force us into a one-size-fits-all plan, though we are relieved when we are finally eligible for Medicare.

In fact, when the Democrats were in control, they rejected the plan that would have worked for all of us - a single payer, improved version of Medicare for all.



By Don McCanne, M.D.

The Republicans keep talking about coming up with a plan to replace the Affordable Care Act (ACA). But as this New York Times editorial explains, their criticisms of ACA are often not fact-based and the proposals they have telegraphed in net would leave us much worse off. Yet, as the Democrats tout the successes of ACA, it is clear that their model falls far short of the high performance system that we deserve.

The health policies that we need are straightforward and are found in a well designed, single payer Medicare for all program. It is the politics that has botched up our health care system.

In a recent Quote of the Day, Jonathan Oberlander’s NEJM article was cited as he explained why the political prospects for single payer are dismal. To change that, we need to listen to and act on his words: “Single-payer supporters have not articulated a convincing strategy for overcoming the formidable obstacles that stand in its way. Nor have they, despite substantial public support for single payer, succeeded in mobilizing a social movement that could potentially break down those barriers.”

The politicians will not lead on single payer; the people must.