The New Yorker ran an especially good cartoon recently: a man standing up in coach on a plane–and others evidently cheering him on–saying something like “Who else is fed up with the smug attitudes of the so-called pilots who fly this plane? Who else would prefer that I fly it?”
The parallels to our Presidential election are too obvious to require added discussion.
I thought about that cartoon when I read another airplane analogy, this time in connection with the Republicans’ hell-bent-for-leather determination to repeal the Affordable Care Act–aka “Obamacare”–without having the slightest idea what they will replace it with, without any evident concern for the more than twenty million people who will lose coverage, and without any concern for the financial chaos that even their allies have warned will ensue.
As Josh Marshall at Talking Points Memo put it:
“The AMA, which has been rather comically pro-Trump to date, came out today and told Republicans that they shouldn’t repeal Obamacare without a clear replacement. Notably, even two of the most conservative health care economists at AEI, came out yesterday and said that ‘repeal and delay’ would be a disaster. The truth is that ‘repeal and delay’ is the policy equivalent of taking off from JFK to Heathrow with 2,000 miles worth of gas and saying you’re going to figure it out en route. No one who knows anything about health care economics, even people who are staunch free marketeers and hate Obamacare, think that makes any sense.”
From time to time on this blog I have referred to my cousin, an eminent cardiologist (and former Republican). I consult him when addressing issues that require medical expertise that I lack. He has shared with me the following statements on the proposed repeal from both the AMA and the American College of Physicians:
Chicago, IL, January 3, 2017––The American Medical Association (AMA) released the following letter today to congressional leadership from Chief Executive Officer and Executive Vice President James L. Madara, MD, concerning legislative efforts to reform the health care system.
Dear Majority Leader McConnell, Leader Schumer, Speaker Ryan and Leader Pelosi:
On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing regarding our ongoing commitment to reform of the health care system and potential legislative actions during the first months of the 115th Congress.
The AMA has long advocated for health insurance coverage for all Americans, as well as pluralism, freedom of choice, freedom of practice, and universal access for patients. These policy positions are guided by the actions of the AMA House of Delegates, composed of representatives of more than 190 state and national specialty medical associations, and they form the basis for AMA consideration of reforms to our health care system.
Health system reform is an ongoing quest for improvement. The AMA supported passage of the Affordable Care Act (ACA) because it was a significant improvement on the status quo at that time. We continue to embrace the primary goal of that law—to make high quality, affordable health care coverage accessible to all Americans. We also recognize that the ACA is imperfect and there a number of issues that need to be addressed. As such, we welcome proposals, consistent with the policies of our House of Delegates, to make coverage more affordable, provide greater choice, and increase the number of those insured.
In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained.
Consistent with this core principle, we believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.
We stand ready to work with you to continue the process of improving our health care system and ensuring that all Americans have access to high quality, affordable health care coverage.
Sincerely, James L. Madara, MD
Washington, DC, January 3, 2017––In a letter sent today to leaders in the Senate, the American College of Physicians (ACP) implored them to vote no on a budget resolution that would start the process of repealing the Affordable Care Act (ACA). The College cautioned that this process could destabilize coverage, resulting in tens of millions of Americans losing coverage, benefits and protections established by current law.
The letter expressed concern that the pathway established by the resolution, which will lead to a subsequent vote on a budget reconciliation bill to repeal major elements of the ACA, with the effective date of such repeal being delayed while Congress attempts to develop an acceptable replacement plan, is unworkable and disruptive.
“Independent and non–partisan analyses show that enactment of such a ‘repeal, delay and replace’ bill, especially without an alternative being offered now that could be thoroughly evaluated based on its impact on quality, access, and coverage, would create chaos in insurance markets, causing plans to pull out of the markets with more than 7 million losing coverage in 2017 alone,” said Nitin S. Damle, MD, MS, MACP, president of ACP in the letter. “Full repeal could result in nearly 60 million people becoming uninsured.”
ACP noted that the College welcomed the opportunity to make improvements in the law. Specifically ACP welcomes discussion of ways to stabilize insurance markets by bringing more young people into them without disadvantaging older and sicker patients; to expand consumer choice of insurance products and of physician and hospitals; to ensure network adequacy; to support state innovation including in Medicaid provided that current eligibility, benefits, and protections for current and future enrollees are not undermined, to reduce administrative burdens on physicians and their patients, and to support the critical role played by primary care physicians in providing accessible, high quality and cost–effective care to all types of patients.
“While we acknowledge that the ACA is not perfect (and no law is) and improvements to it can and should be made, our continued support for the ACA is grounded in the fact that it has reduced the uninsured rate to the lowest ever, a major stride toward providing affordable coverage to all Americans,” said Dr. Damle. “We encourage Congress to first put forward ideas for improvements rather than committing to a process that would repeal the ACA’s coverage and protections for many millions of people.”
But what do pilots know about flying planes…?