Thursday, March 30, 2017

Tearing Down / Building Up

To quote Mortimer Snerd (whom a few of you may remember), “Who'd a thunk it?” Last Friday the bill to repeal and replace “Obamacare” was pulled from the House floor. Thus, the ACA is still the law of the land “for the foreseeable future,” according to Speaker Paul Ryan.

For seven years the Republicans have been opposed to the ACA. The U.S. House of Representatives has voted to repeal or amend ACA more than 50 times since it was passed in October 2009.

As Time reported last week, “Republicans took control of the House in 2011, and on January 19 of that year they voted on, and passed, a measure to repeal all of the Affordable Care Act. (It was never considered by the Senate).”

Before and since his election, Pres. Trump has publicly promised at least 68 times that he would lead in repealing and replacing Obamacare. Here is what he tweeted on Feb. 14: “Obamacare continues to fail. . . . Will repeal, replace & save healthcare for ALL Americans.”

(Those 68 statements can be found at this website.)

There is a big difference, however, between tearing something down and building something to take its place.

In thinking about the failure of the American Health Care Act, I was reminded of an anonymous poem that I first heard 60 or so years ago (in spite of a woman claiming on the Internet that her grandfather wrote it in 1967). 

The Republicans found out that it is much easier to repeal (tear down) the current healthcare system that to replace it by building a new healthcare program. Wrecking is much easier than building.

So, where does national healthcare go from here?

The current impasse could be overcome and a new and approved healthcare system could be implemented in this way:

First, Democrats would agree to call an improved healthcare system by the name of the Republican bill that was never voted on: the American Health Care Act. It would no longer be called Obamacare—just as it should probably never have been called that in the first place.

Then, the Republicans would agree to work with the Democrats in improving (building up what is already in place) the parts of ACA which are not working well: making it more affordable for everyone, giving people more choice, continuing to expand the program to cover all Americans, and so on.

Senate Minority Leader Schumer has already indicated willingness to cooperate in the hard work of building a better system. He is reported as saying, “If they [the Republicans] would denounce repeal . . . then we’ll work with them on improving it and making it better.”

Bipartisan efforts to build a better healthcare system is, doubtlessly, what the vast majority of the American people want—although it would still be opposed by those on the far right.

The latter would, also doubtlessly, continue to oppose having the federal government directly involved in healthcare, having equal or greater demand for taxes to pay for the continued (or expanded) program, and of not having tax breaks for the wealthy.

Constantly opposing any plan to tear down the current system and thus deprive millions of people from healthcare coverage, citizens who are concerned about all the people in our nation must demand that Congress build up (repair) the current healthcare system so it is better for all.
For those of you who may be interested, here is the rest of the poem cited above: 


  1. Building up a better healthcare program may be difficult and take time, but it shouldn’t be impossible. And with enough time and effort, it might even lead to the building up of what would be best: a single payer system, such as most of the highly “developed” countries of the world have.

  2. Thinking Friend Eric Dollard has just sent pertinent comments that admirably amplifies the brief comment I made above. Thanks, Eric!

    "Thanks, Leroy, for bringing up this contentious issue. I am sure almost everyone has an opinion about it.

    "The main problem is that many or most Republicans in Congress do not believe that universal healthcare coverage should be a national goal. They would prefer to take the government completely out of the health insurance and healthcare business, but politically they are hamstrung because too many people would lose coverage.

    "Although the ACA has extended coverage to about 20 million Americans, universal Medicare would be better--and cheaper because healthy individuals would be forced to pay into the system through the Medicare tax (which would certainly be higher).

    "It is delusional to believe that the Republicans, or anyone, can fashion a cheaper, more inclusive health insurance system without a single payer and without everyone paying into the system. They can certainly fashion a system that is cheaper for the federal government, as they had proposed, but millions would lose coverage.

    "Universal healthcare coverage is the norm in most OECD countries, but not in the U S. Countries with universal healthcare have lower costs, lower rates of infant mortality, and higher rates of longevity. We should look at healthcare systems in other countries to see which ones are the most efficient, but don't hold your breath; too many special interests would lose too much money."

  3. The ACA was a very bad (and purely partisan) bill from the beginning. I negative see the results daily of people forced out of the ACA (sic) because it is unaffordable, or forced to compromise the family budget (including ours) to buy something which they cannot use (up to $20,000 deductibles which would bankrupt them before the insurance kicked in). The ACA is a financial disaster for families and businesses. A total repeal is in order. (This devastation effects up to 15,000,000 so I have heard.) What a tragedy that this was implemented in the first place. Before the ACA, healthcare inflation rate was around 10%. Two years ago it was 42% for me, and last year it was 26% Support of this is unconscionable. And it still is not solvent. If the foundation is irreparably broken, demolish the structure and start again, regardless of how pretty the facade is. This is the singular reason I did not vote Democrat for any DC office in the last election. (Not that the Unaffordable Republicare Act would have done much to address the affordability issue, other than eliminating the devastating penalties - I don't trust anyone in DC.)

    Repeal, then start again in a BI-partisan manner to create something AFFORDABLE.

  4. Local Thinking Friend Don Wideman makes this comment:

    "Good time for and good use of that poem! Remember when preachers memorized poems and quotes?"

    1. Thanks for writing, Don.

      I am not sure I memorized it completely, but I am pretty sure that I used this poem in a sermon (maybe more than one) at my first pastorate (1956-59), which is why I couldn't agree that it was written in 1967.

  5. Here’s my reaction and take on this, for further reaction.
    Creating an “American Health Care” system that represents at least some input from across the diverse interests in our country is the goal. Creating a system that “wins” politically by one or two last minute pressured votes (which is what happened with the “Affordable Care Act” in the House of Representatives in a shady power play) is not the way to go. To be sustained, a social program needs broad support. It was hubris of the President and the Democratic party to go along with the catchy moniker “Obamacare” meant initially as a criticism,, whether it was believed to be a “legacy” result or not.
    There was a moment, previous to the legislative final shaping of the bill that passed, when hospitals, doctors, the insurance industry and consumer representatives were all convinced the healthcare “system” was broken and needed change. Many Democrats, as well as Republicans did not think of the bill that passed as finished. They recognized the need for continuous adaptation. Which brings us back, sort of, to where we are, but with battle lines drawn more clearly and more firmly.
    What has been achieved, it seems to me, is that a move toward universal coverage has won large support in the general population of voters, if not among our elected representatives. Universal coverage is based on moral judgements of what is right for a country and is also based on the country’s ability to pay for universal coverage. It means being clear on the extent of what will be covered and for how long. “Universal care” nowhere means the government pays for everything for everybody as long as needed.
    There are numerous improvements to be made: e.g. negotiated pricing for services and pharmaceuticals, some limits on the financial liability of various providers. Government setting of certain boundaries, not the “invisible hand” of market forces only, need to be accepted by the country as the most reasonable and ethically responsible way to go. The financial ability to maintain a system of universal care depends on what the country is already paying for Medicare, Medicaid, other fixed rate entitlements and what it is paying for Defense, the military and engagement in war. We have a ways to go to create a fair, ethical healthcare system.

    1. Thanks for your thoughtful comments, Larry.

      I usually am in significant agreement with what you write, but this time I see things a bit differently. You refer to the "shady power play" when the ACA was first passed. As I see it, Pres. Obama and most Democrats saw universal healthcare as so important they pressed toward getting it enacted in spite of 100% opposition by the Republicans. From the beginning they much preferred having bipartisan efforts to create the new healthcare system.

      About "Obamacare": that term was first used in opposition or criticism of the ACA, as I understand it. It was not a term Pres. Obama or the Democrats coined or desired. But when it became popularly used in the news media and elsewhere, they also began to use what had become a common term. I don't think that was particularly due to hubris. It was just acceptance of what had become popular usage.

      The new healthcare system could have been, and should have been, a bipartisan effort to help all the citizens of the country get healthcare. But since the Republicans would not participate, the Presidents and Democrats had to do it without any Republican support. While that was certainly unfortunate, I don't know that it was particularly "shady."

      I do agree with your concluding statement. And I hope and pray that there will be bipartisan efforts "to create a fair, ethical healthcare system." But given the polarity we see in the current government, I am not optimistic.

  6. While he is certainly not for a single-payer system, I was interested to see what Charles Krauthammer said about that in his op-ed piece in today's Washington Post. He wrote,

    "A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now."

    This is directly related to the comment I made above soon after posting this article yesterday.

  7. Healthcare is a prime example of the chasm between Wall Street and Main Street. Amoral corporations have demonstrated a capacity and a willingness to exploit every opening to maximize profits. Only a massive public resistance has kept them from completely turning healthcare into a total profit center with benefits for those who can pay, and death and disability for those who cannot. Look at what they are doing to clean air, clean water, clean energy, civil rights, voting rights, research and development, emergency preparedness and so much more. The bottom line for most GOP (and many Democrats) is what will make the most money possible for Wall Street donors. They want to cut taxes for the rich, cut spending on national priorities, and increase private profit from what cannot be cut. Look at the rush to private jails, private toll roads, private schools, and private military contractors.

    Who is looking out for the common good and the more perfect union? Not very many, and it is increasingly showing. How will our Western culture end? Global warming? International terrorism? Bankruptcy? Massive pollution? Unsustainable political structures? Does it really matter? The four horsemen are circling, waiting for the trumpet to sound. Well, one Trump has been sounding a lot, usually in a Russian oligarch key. We cannot solve healthcare without solving the deep disfunction that has lead us to this place.

    I have been reading about Julius Caesar, and something that has struck me repeatedly is the profound similarities between the late Roman republic and our own. Rich oligarchs block reform for tactical political advantage, ignoring the needs of the Republic. Increasing inequality drives farmer/soldiers off their land and into poverty, even as the great estates of the oligarchs set the stage for feudalism. Rampant corruption undermined both justice and elections. Rome eventually paid the price in barbarian invasions and the dark ages. Will we get off that easy?

    1. Craig, thanks for your thought-provoking comments. I largely agree with what you have written. But, perhaps, I would quibble with your term "amoral" in your second sentence. Maybe "immoral" would be more accurate.