Chunk 10: Don’s Party.
Having spent the past few days trying to understand the US healthcare system, I’m ready to offer my medical opinion: I have a terrible headache.
The subject is ridiculously complicated; their system is so much different to ours here in Australia. Most Americans receive their insurance through their employer; except if your 65+, then you get it from Medicare; except if you’re poor, then you get it from Medicaid, which is co-paid by both the federal and state governments (with the amounts differing from state to state), except if you don’t have any insurance at all.
Mostly, it has made me extremely grateful for that green card in my wallet, and the 1984 introduction of Australia’s universal health cover, Medicare. Bob Hawke, I could kiss you on the mouth, except for … well, moving on.
If only to justify my enthusiasm, let’s quickly look at America’s medical alternative, and why they dearly wished they had it as good as us.
On average, Australia spends about $4,971 on healthcare per person, per year, versus $10,207 for the same in America. We live about four years longer, have a lower infant mortality rate, whereas the US’s maternal mortality rate is five times higher. So, yay for us.
Barack Obama attempted to address these - and other - shortcomings when he passed the Affordable Care Act (Obamacare) in 2010. You remember, that was when now-Democratic presidential candidate Joe Biden famously told him in front of a live mic, “This is a big f…...g deal!”?
For such a convoluted system, Obamacare’s intentions were very simple: provide better, cheaper healthcare to more Americans - especially the 30 million who had no coverage at all - and force greedy insurance companies to cover people with pre-existing conditions. So, has it worked? Well, let’s see:
15% of US citizens were completely uninsured in 2010. By the end of 2019, that was down to 9%.
Costs have continued to grow, but at a much slower rate than previously.
Pre-existing conditions are nearly completely covered.
All in all - despite insurance premiums continuing to rise, certainly more than promised - not too bad a result. It’s probably why, if elected, Joe Biden has promised to build on Obamacare, with healthcare regularly topping the list of issues Americans are most concerned about.
Then why, ten years on, with most people in favour of it, and in the middle of a global pandemic, is the Republican Party trying, for the third time, to kill Obamacare in the Supreme Court? Because their argument for doing so this time, oh, it’s a real doozy.
Try and follow this logic …
At the heart of the Affordable Care Act was something called the “individual mandate”. Essentially, to create a kitty large enough to cover all of America’s medical expenses, Obamacare needed everyone to sign-up for it (that’s where that “socialised medicine” thing comes from). And if people didn’t, they would receive a tax penalty. They’d be fined.
Donald Trump tried - unsuccessfully - to repeal/get rid of Obamacare entirely, but ultimately didn’t have the votes in the senate (that was the whole John McCain thumbs-down thing). Trump did, however, manage to use tax legislation to get rid of the individual mandate.
So, the mandate is still, technically, on the books; but it’s for zero dollars. Didn’t sign up for Obamacare? Then we’re going to tax you nothing extra. But now, the Republican Party is going back to the Supreme Court to argue that Obamacare should be thrown out completely, because it still includes mention of the tax - that no one pays because it’s 0% - arguing that it’s unconstitutional.
Or, if you like, think of it this way: imagine a wife wants to host a party, and says that everyone invited has to bring a plate of food. Her husband disagrees and says, no, no one should be made to bring a plate of food. He then takes it one step further and declares that, because the party invitation ever mentioned bringing a plate of food, the party must be cancelled entirely, because no one should have been asked to bring a plate of food to begin with.
Now imagine that husband is Donald Trump, and wonder why he had been married three times.
