The Republican health plan just doesn’t make sense


Like they have a gun to their heads, congressional Republicans, led by Paul Ryan, are moving ahead at warp speed to pass a sweeping new health care bill to replace Obamacare. Despite an almost deafening roar of objections from the many people who would lose coverage or whose insurance costs might go up; from major medical groups; and even from within its own party, they continue onward with this health care Blitzkrieg.

But why are they doing this? It doesn’t make sense.

First of all, their plan does not appear in any way to fix the major problems associated with the American health care system. Most importantly, it will not improve access to care — quite the opposite in many cases. Most media and expert analyses contend that huge swaths of patients who had been covered under Obamacare will lose their insurance. Nor does it reign in health care costs in any direct manner. Their hope is that by removing Obamacare mandates, its subsidies (to be replaced by tax credits), and other basic insurance coverage requirements, that market forces will be unleashed and will magically bring costs down. And finally, there is nothing obvious in the bill that would improve the quality of medical care, the third of the major problems associated with the American health care system.

The plan may also prove to be incredibly damaging to the Republican Party in a political sense. If the early response is any indication, it appears that “Ryan-Trump Care” could be worse for the Republicans than Obamacare was for Democrats — and yet there is almost no hesitation to push forward. Why would this be such a priority for these Republicans when they just solidified their majority? Even in their own party, the plan elicits major objections. Moderate Republicans object that the plan will hurt too many people. Tea Party Republicans, on the other hand, object that the plan’s tax credits and protections are too much like Obamacare.

And finally, the new plan runs counter to any semblance of the Christian values that many Republican politicians claim to hold so dear. Many people have suffered, and died, at the hands of our broken health care system. There is every indication that this new plan could continue, and even worsen, the carnage. Preventing such suffering no longer appears to be an important priority.

It just doesn’t make sense on so many levels. The most common explanations of their motives are unsatisfying. Clearly, the Republicans had a deep-seated hatred of Obama and Obamacare, his signature accomplishment. But why not replace it with something that would be more likely to work?

The rationale most commonly cited is that Republicans’ current thinking regarding health care reform reflects their deep commitment to an anti-government, pro-free market orthodoxy. According to this way of thinking, the only way to fix health care is to remove government intervention entirely in the hopes that the supply and demand of literally thousands (if not millions) of markets for the goods and services that comprise American health care (and the insurance that pays for such things) will magically sort themselves out in the most accessible, low cost, high-quality system possible. It is a radical ideology where values are determined solely by whatever proves to be most profitable.

But this is neither a realistic expectation of the “free market,” nor an entirely desirable way to make decisions regarding health care or for our nation. We have and always will need government to fill in the gaps between citizens’ needs and what even the most robust economy can provide. Even more important, there are essential values that are non-economic, like religious or ethical values, that may not always be in line with what is most profitable. America has always tried to balance values that support a free and open democratic society with an economic system (capitalism) that mirrors and supports the same things. Supporting those values is a legitimate and desirable function of government, as long as it is done in a balanced manner that does not infringe on economic freedoms to too great an extent. But this new radical Republican ideology places capitalism over everything else.

It is only within this radical belief system that it is ok to perpetuate the suffering of millions of Americans. But it also flies in the face of common sense and common decency. So why would anyone adopt such a confounding ideology?

In medicine, we are taught that when patients behave in an unexpected or confounding manner, to consider secondary gain or a secondary agenda as the cause. For instance, when a patient that stands to gain from being ill or hurt (i.e., when there might be financial gain from a lawsuit that stems from the illness) does not comply with therapy, it might be because of the monetary gains they associate with continued illness.

It is certainly reasonable to wonder whether the Republicans’ emphasis on this unbalanced, potentially harmful ideology stems from some secondary agenda. And when wondering about such things, it is also reasonable to follow the money. According to Open Secrets, Paul Ryan has received $657,649 from the insurance industry and $395,274 from the pharmaceutical industry in campaign contributions. So, is it possible that Ryan’s ideological purity is a front for his desire to raise as much in campaign donations as possible? When such blatant conflicts of interest exist, it is reasonable to wonder.

America is at war — a war of ideas — where a radical economic ideology, or the will of wealthy campaign donors, or both, trump sensibility, truth, science, and even common decency to perpetuate a broken health care system. Many have needlessly suffered and died in this battle. It appears the American people will have to fight this war, and win, if they want a working health care system.

Matthew Hahn is a family physician who blogs at his self-titled site, Matthew Hahn, MD.

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