Collective denialism - Part 1
In 2009 President Obama sat down with House Republicans for a round table discussion on health care. He laid out the reasons why the Affordable Care Act was necessary. I'm not as eloquent as Obama, but I'll paraphrase the points he made.
Health care costs were increasing rapidly in the 2000's. One of the reasons why was that emergency rooms were treating a significant number of patients who did not have health insurance and could not afford their bills. Hospitals were often stuck holding the bill and as a result they would have to increase costs on tests and standard supplies (which were paid for by patients who did have health insurance) in order to offset those losses.
There were a couple of big problems with that system. The first was that it irrationally inflated costs on certain supplies to the point where someone might be billed $100 for a simple bandage or an aspirin. That's a nightmare from a business accounting perspective because you have no idea about the true cost of anything. The second problem was that it set up this incredibly inefficient system in which people who couldn't afford health insurance would put off going to see a doctor, and in so doing would make their medical issues worse, and much more costly to treat (often at the emergency room - without being able to pay the bill).
The solution to those problems is the individual mandate. The individual mandate requires that everyone have health insurance. People who can't afford health insurance are given subsidies so that they can afford it. Once everyone has insurance, hospitals won't be stuck holding the bill, and people will go see a doctor for preventive care, which is far more cost-effective. The individual mandate only works if health insurance companies are forced to accept everyone, regardless of preexisting conditions. Otherwise health insurance companies can just reject the sickest people and we're back to where we started from.
Given that health insurance companies have to accept everyone, there has to be enforcement of the individual mandate, which means that people who don't get health insurance will have to pay a fine. Otherwise people will just wait until they get sick to buy insurance, which is not how insurance works, and it ends up making health insurance more expensive for everyone.
That's it. A very simple set of axioms that lays out the broad outline of the Affordable Care Act and why each part of it is a necessary part of the whole. Back in 2009 Republicans were opposed to the Affordable Care Act, and they continue to oppose it now. The problem I have with how they talk about their opposition is that they have not shown their work so to speak. They have not been honest about what it is that they're arguing for. This was recently taken to its illogical extreme when Donald Trump said that he's going to repeal Obamacare and replace it with something much, much better. That promise carries about as much weight as if it came from a high school freshman running for class president.
There is an alternative to Obamacare, other than going back to how things were in the 2000's. The alternative is that emergency rooms stop accepting every patient that collapses in front of their sliding doors. The alternative is that emergency rooms ask to see your insurance up front, or if you don't have insurance, they ask for proof that you can afford the services that are being offered. The alternative is that hospitals choose levels of care based on what you can afford rather than what would be the most effective medical treatment. The alternative is that Cadillac health insurance plans will be vastly different than budget health insurance plans in terms of treatment options. The alternative is that poor people will not always get the treatment they need, even if they do have insurance.
I would love to hear Republicans argue for that alternative. Honestly, I think it's OK to make that argument. Health care is not a constitutional right in the United States of America. At least not at this moment in time. It's OK to argue that poor people should not get everything that rich people have. It's OK to argue that there should be winners and losers when it comes to health care. It's OK to argue that people in their 20's who think they're invincible and make bad decisions like not buying health insurance should have to pay the price. It's OK to argue that there should be limits on how much money health insurance companies should have to pay out for their sickest members. But Republicans don't make those arguments. They argue against a straw man like "death panels". They argue based on an ideological position that refuses reality and truth.