There are three core provisions that must be wrapped into effective health care coverage.  They are simple concepts that are, however, proving extremely difficult to implement. First, the plan must bring broad and readily available coverage to underserved populations. The “served” populations are already covered, with many among the fully employed having health coverage through their work. It is the working poor, the disabled, and those without coverage for any of a variety of reasons that must be brought in to the plan.  Those are the people who are often forced to wait until they are in medical crisis to seek care, and then who do so through the least efficient methods, such as using emergency rooms. Obamacare sought to correct this unequal distribution of coverage through penalties on employers and on individuals (an unpopular methodology at best), and through subsidies for lower income populations.  It was an imperfect plan at best, but it did result in significant reductions in the uninsured population. Both the original Republican repeal-and-replace plan (let’s just abbreviate that to R-R&R, eh?) and the current (May of 2017) proposal will have the opposite effect, and will likely result in 24 million MORE people becoming uninsured. That moves the needle in the wrong direction.

Second, any plans must be simple enough for average Americans to understand. Engagement is key, and costly surprises are counterproductive. In this, Obamacare failed.  As do both the R-R&R plans. They are all complex, unwieldy, convoluted and difficult to both understand and to navigate.  I have been involved in designing, selecting and implementing health coverage for businesses for many years, and I am pretty darn proficient in the language and structure of medical insurance plans. When I and many of my peers with similar or greater skills are challenged to fully and easily understand these plans (Obamacare and both R-R&R proposals) I cannot see how the average American could do so without herculean effort. When it takes tens of thousands of pages to set forth the rules and regulations governing a system, that system is self-evidently complex. That is exactly the opposite of what we all need.

Finally, and perhaps most importantly, any effective reform must prevent the payors from excluding people (by fiat or by cost) based on pre-existing health conditions.  Obamacare was a step toward that but was not perfect. The first R-R&R did little to change those provisions, unlike this current proposal which completely eliminates them by allowing the States to do so at will.  Changing the hangman does nothing to alter the fatal drop at the end of the rope. It is this last proposed change that is cruel, unnecessary, and despicable. It seeks to balance the political tables on the backs of the poor and the disabled.  It uses vulnerable people as cannon fodder in a war of words between the ultra-conservatives (mostly Republicans) and the moderates of both parties. It holds the American concept of fair play in contempt. It is nothing but a bunch of school-yard bullies kicking the kid who walks funny for their own ends. That’s no fun. I know, I’ve been there (not as the bully, just to clarify).  It’s time for the extremists on both sides to give up the concept that they have some divine right to force their narrow beliefs down all our throats. It’s time for them to stop playing with people’s lives and start representing them instead.  What are your thoughts?  Comment or e-mail me at dbdolnick@gmail.com.