Shim, Sham, or Shame

It may seem surprising to some, but I was once an innocent child, a little neophyte in the big bad world. I can recall the time I saved my dollar-a-week allowance in order to buy my mother an overpitched donut maker. The TV huckster promised to include “for free” an array of cookie form-cutters. What a deal! And my purchase came with side benefits any eight year old could appreciate. My mother, out of deference to my naiveté, actually made use of the donut maker, but just once. I never saw it or the cookie cutters again. I only vaguely remember the miniature donuts she made and the toy-like plastic implements my frugality bought for her.

If you live in a consumer society—as we do—then you become accustomed to clearance sales, close-out sales, 50% off bargains, and “free” add-ons to avidly hocked purchases. But if you are a discriminating consumer, then you probably ignore the huckster and search for the product or service that best fits your need and matches your budget. Maybe this is the time to bring that same discrimination to our politics. Apathy can mirror innocence for it makes us equally naïve. And information hucksters have undermined our discrimination by veiling the truth behind a wall of self-serving lies and falsehoods.

A carpenter shapes and tapers a shim to make a finished product, like a piece of furniture or a wood structure. In my last blog (reference “Why Repeal and Replace Obamacare?”), I offered several scenarios that would further reduce healthcare costs and improve Obamacare. As a layman, I likely lack the expertise needed to create the best possible finished product. But I believe I have the right approach: let’s make Obamacare better or, if you will excuse my metaphor, design a shim to fill in the cracks. Instead, Republicans want to repeal and replace, that is, to obliterate the current product and build a replacement from scratch.

The Republican leadership has already decided how best to sell Obamacare’s replacement. It has been pitched as the only alternative for avoiding the inevitable collapse of the current system. That alleged collapse is something Republicans have continuously tried to accomplish by discouraging enrollments with negative propaganda and by strangling insurance company participation in the exchanges with court injunctions and the defunding of the risk corridor. Now that Republicans have control of Congress, they can simply defund Obamacare under the guise of tax reform. Without the .9% income tax or 3.4% investment income tax for incomes over $200,000 ($250.000 for married couples), Obamacare subsidies would disappear. Since eight of ten subscribers enrolled through the exchanges depend on these subsidies, the current self-funded Affordable Care Act would be gutted. And Obamacare would indeed collapse. But it would not collapse of its own weight, but by the will of Congress. If Republicans can hide the truth that Obamacare benefits everybody, not just enrollees in the exchanges, then they might convince the majority that repeal will not affect them. In addition, if they can secretly defund Obamacare under the pretense of tax reform, then they might win support for its replacement. For any healthcare system would be better than a failed one. In other words, if you can keep Americans in the dark, they just might be naïve enough to buy an inferior product, like my eight year old self buying a toy donut maker. This Republican strategy to save Americans from an allegedly inevitable Obamacare disaster is really a sham.

If I am not alone in calling out this sham, then perhaps enough of us can inspire Congress either to design a carefully designed and molded shim for Obamacare or to create a healthcare system that will match and exceed its accomplishments. One legislator has proposed a “patient/doctor centered” healthcare system that reportedly will provide tax deductions to fund individual health savings accounts (HSAs) and will establish an interstate insurance exchange market. But apart from its catchy name, it leaves many unanswered questions on the table. How will these HSAs be funded if low income tax returns cannot benefit from tax deductions? If a tax deduction cannot provide funds for an HSA, will the Federal Government simply pay for it? How much money will be provided for these individual HSAs? Will it cover catastrophic illnesses? Will insurance company profits be capped? Will new Federal insurance regulations override differing individual state regulations to provide uniform practices across state lines? Will these new regulations fall under the federal jurisdiction of interstate commerce or be a violation of state rights? Will the universal benefits of Obamacare be preserved? How will a proposed replacement system be funded? How will healthcare costs be affected? Without answers to these questions—and probably many others I do not have the expertise to raise—the prospect for an adequate replacement system seems remote or, worse, a false and perhaps misleading promise. And that would be a scam played on all Americans. It would also mark our legislators with unremitting shame.

Your comments are always welcome - I value your opinions!