Politics vs. policy, front and center

By Michael J. Pramenko, M.D.

“Nobody dies because they don’t have access to health care.”
— Rep. Raul Labrador, R-Idaho, May 5

“It does require some courage to champion the vulnerable and the sick and the infirm.”
— Barack Obama, May 8

On April 9, a physician was dragged off a United flight that was overbooked. The event, involving one single American, triggered national disgust and a public hearing in the U.S. House of Representatives. During that hearing, United Airlines’ CEO faced questions regarding the treatment of the passenger and was told that his industry faced possible new regulations if they didn’t clean up their act.

Now, fast forward three weeks and into the zone of ideology and trickle-down economics. On May 3, the U.S. House of Representatives voted to remove millions of Americans from access to private insurance and Medicaid. In a way, millions of Americans stand to be dragged off the “plane” of health care access via the American Health Care Act or AHCA should the U.S. Senate follow the House plan.

Amazingly, legislation dealing with the health care delivery system of 326 million people had one less public hearing in the House of Representatives than the United flight boondoggle. Zero.

Repeal and replace? That is shorthand for repeal health-care access and replace with a huge tax cut for the wealthiest of Americans. Trumpcare has now been defined.

Indeed, the American Health Care Act is an odd name for this legislation. It neither reflects American ideals nor does it promote healthcare. It is a tax cut and a poorly designed token response to a seven-year-old campaign promise. Americans making more than $1 million per year stand to see a tax cut of more than $50,000. Billionaires and millionaires have “drained the swamp” and replaced it with a pasture of cash cows.

Our current president, the same candidate who advocated for universal health insurance last fall, celebrated the AHCA and its provisions that take us in the opposite direction. Our current president, the same candidate who promised to cover pre-existing conditions, boldly celebrates legislation that directly jeopardizes that consumer protection. Our current president, the same person that recently applauded Australia’s single-payer system as much better than our health-care system, declares victory with a Rose Garden ceremony for a bill that weakens the middle class.

Seriously, the late libertarian author Ayn Rand could have penned this legislation.

We know that many conservatives in the House of Representatives view the redistribution of wealth as a fiscal disease. Providing health-care access to all Americans, in their view, is un-American. Seeing that raw ideology translated into actual policy proposals paints a clear picture. It’s cold and dark.

The Democrats would have given you a single-payer system instead of Obamacare had they adhered to strict ideological principles. And remember, it was Ronald Reagan who signed legislation in the 1980s that enshrined the right to health-care via the emergency room. That “right” or entitlement became law decades prior to Obamacare.

Anytime a patient is seen in the emergency room, we convert to a single-payer system. We all pay for that right via taxes or higher health insurance premiums. Finally, seven years ago, Obamacare provided insurance and access to care that helps people avoid the emergency room. Obamacare covers pre-existing conditions and guarantees a certain level of coverage via essential health benefits. Obamacare, even with its imperfections, strengthened the middle class.

Trumpcare, now currently defined by the AHCA, offers little to the poor and lower middle class. And for those of you with pre-existing conditions, watch out. Markedly higher premiums or denials of coverage are once again in the future.

The U.S. Senate should treat this legislation with the respect it deserves — the legislative trash bin. They should not embarrass themselves by trying to fix a fallacy. The U.S. Senate should right this ship by starting over. They should have public hearings and talk with experts in health care delivery. They should talk with patients, nurses, doctors, and families. Properly reforming health-care delivery requires months of deliberation and open debate.

Mr. Trump became president promising something “great,” something universal, and something that covers pre-existing conditions. The president’s own words ought to guide the Senate’s legislative process.

However the debate unfolds, “making American great again” should not involve paying for tax breaks for the richest Americans by revoking health-care access for millions and kicking folks off the proverbial United States health-care plane. Greatness, unlike greed, takes courage.

Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He is Chairman of the board of Monument Health and is a past president of the Colorado Medical Society.


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