Answer: In terms of policy, they don’t cover many people and they are not very cost-effective. In terms of Catholic social teaching, they violate both solidarity (taking care of the less fortunate directly) and subsidiarity (removing impediments to furthering human dignity in the private domain). There are many different ideas floating around, often with little coherence between them, but they do share a common trait – the desire to move healthcare away from a communal to an individual concern. Just look at some of the common ideas – tax credits, ending tax breaks for employer-based insurance, encouraging high-deductible coverage, turning Medicare into a voucher scheme that moves away from guaranteed benefits. All of these ideas reward the young and healthy, while leaving those who need care the most in the lurch.
It is really an ideological position, based on the cult of individualism, the liberal sense of responsibility for one’s own destiny. There are a number of ways to achieve universal coverage. One is simply to subsidize it without any reforms, or to move toward an individual system and dish out subsidies. The problem is that this becomes incredibly expensive, unsustainably expensive, as the healthy are abandoning their responsibility to help those in need. The other way is to put everybody in a pool, the sick and the healthy, the young and the old, without discriminating. Many countries do this through a single-payers system, which cuts down on excess administrative complication. Other countries rely on private insurance, combining some form of community rating (no discrimination based on health status) with an individual mandate (making sure that the healthy simply don’t “go it alone” to reduce their costs). In a nutshell, this is what the Affordable Care Act does, aided by some subsidies for those on lower incomes.
Remember, this used to be a Republican idea. It was once the bedrock of Republican opposition to the more centralized approach of the Clintons. It was the approach taken by Romney in Massachusetts. But today, the crazy individualists call the shots. The problem is, when you start from this position, it becomes virtually impossible to reform healthcare. The Republicans seem to be finally understanding that circles can’t be squared, and are simply backing away from universal healthcare as a policy goal. Let’s be clear that this stands starkly against the tenets of Catholic social teaching. They can approach it from different angles, but they are not permitted to abandon it.
Let’s look at some of their plans. In 2009, the CBO evaluated the Republican plan, noting that it left 52 million still uninsured, and saved dramatically less money that the Democratic alternatives. The only good idea in this plan was tort reform – this doesn’t get you much, but it gets you something, and is worth considering. Or go back to the 2008 John McCain plan, based on tax credits, would cover fewer people and cost dramatically more (at least twice as much), while leaving much uncertainty over the quality of insurance.
Possibly the biggest talking point in Republican sources is the plan to let insurance companies compete across state lines. This feeds directly into ideological comfort zones about unleashing the wonder-working power of the free market, oblivious to the evident imperfections in the healthcare market. If it is the most popular position, it is also the most dangerous. Think about what this means. The individual market is completely dysfunctional, with massive discrimination based on health status. The quality of coverage is often pathetic, and lies behind the chronic problem of under-insurance that exists alongside uninsurance. And the fact that people with pre-existing conditions can get anything at all is usually due to state-level regulations. What would happen if the Republican plan went into operation? The same problem as always in an unregulated healthcare market – the young and healthy would flee to purchase cheaper insurance from low-regulation states, and there would be a race to the bottom. And the insurance companies would start flocking to these states too. This is an absolutely disastrous idea, where the true scale of disaster is hidden by ideological blinkers.
One more thing. For Catholics, coverage of abortion in health insurance plans is a huge issue – for many, the over-riding issue (let’s ignore the charlatans who hijack the unborn to serve the golden calf of the market). We know that the Affordable Care Act does not allow taxpayer funding of abortion, and any potential loopholes are covered by an executive order. The real issue is whether the Hyde amendment should be codified into permanent law, or left as an annual rider, as it has been since the 1970s. At least, people are finally realizing that this is the real issue, as the smoke from the incendiary devices thrown about by the National Right to Life Committee and their allies begins to clear.
But when compared to the impact of the Republican plans on abortion funding, this suddenly seems like the most marginal issue in the world. Tax credits? A massive government subsidy for the purchase of private plans that include abortion – since there is no appropriation, there is no way to restrict this subsidy right now. Second, think about the plan to allow competition across state lines. One of the strong points in the Affordable Care Act is the ability of the states to ban any plans offering abortion from accessing the exchanges. This applies to all plans, not just those accepting federal subsidies, and so – by regulating private insurance directly – goes well beyond the Hyde amendment restrictions. This would be gutted by Republican plans, as this could easily be circumvented by going to another state. I wonder why our Catholic friends on the right don’t mention these points, don’t you?
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