May 31, 2018

The Republicans in Congress are apparently leaving behind the drive to repeal and peplace the Affordable Care Act. But don’t worry, members of the Democratic Party may, if they win majorities in both houses of government, try to do it for them.

The Republicans failed on one of their principle promises of the 2016 general election for a variety of reasons. Part of the failure was because the public liked some of the features of the law, while others worried about the cost of any new program. But the main roadblock was while most of the GOP congressional delegation agreed to the repeal part, the replace part left them in disarray.

But just when you thought it was safe to go back to your doctor, a liberal wing of the Democratic Party has its own plan to repeal and replace. According to these advocates what the country really needs is a single-payer, government-run health care policy. Sometimes it is called Medicare for all.

My first point is there is nothing wrong with this advocacy. In fact, since the Republicans have decided on a different focus in the upcoming election, we will be deprived of robust discussions on the Republicans’ plan to improve health care availability and affordability vs. the Democrats’ counterproposal. Elections are, after all, supposed to be about choices.

But I wonder if the political centrists might just want to step in here. While the extremes of both parties want to tear up the accord, one to just stop it and the other to start over, there is another and maybe a better, way.

The Affordable Care Act is not perfect, but few can argue it is worse than what we had. It hasn’t been so long ago for many that we can’t recall what it was like without ACA. Remember when if you had a pre-existing condition, like a bad back, you could get health insurance for everything but your back. If you used your insurance coverage for any reason, you would see your annual insurance premium skyrocket the next year. If a person did get deathly sick with catastrophic medical bills, they would be informed they were no longer covered because they had reached “their maximum lifetime limit.”

In defense of the health care industry, another fundamental cost of continuing rising annual insurance policies was the fact those with insurance had to cover the cost of treating those without.

Just in Iowa alone, for example, the number of people without health insurance in 2013 was 248,000, but by 2016 that number had been reduced to 132,000, a 46.8 percent difference. States prudently took advantage of Medicaid expansion, greatly expanding coverage. True, privatization of the program has been a disaster in Iowa, but a new governor could fix that with the stroke of a pen.

The Republicans run the danger that in destroying Obamacare they may lay the groundwork for the need of a government-run health care system. For Democrats, the reality is they do not have the votes or the public consensus for a Medicare for all program. It would be better if both worked to remove features the GOP finds offensive and for Democrats to improve this market-based system.

Lord Melbourne was a British Prime Minister of the mid-19th century. He was a member of the Whig party, generally regarded as the counter-balance to the opposition party, the Tories. He confounded his critics when he said he was a conservative. His explanation for this contradiction was simple. He was a conservative because, as a liberal, he wanted to make such changes as were necessary to preserve the best of what Britain possessed.

We cannot reincarnate the good man, but it would be helpful to the republic if we could elect a few men and women who would work to reform, along acceptable political lines, health care availability and affordability. This would be far better than the two remedies being pursued at this time.

Dave Nagle is a Waterloo attorney and former U.S. congressman.