Opinion: A 'Richer' Appreciation Of The AHCA

May 17, 2017

Credit Mark James / Flickr

There have been a number of people and groups who have been critical of the American Health Care Act. And I’m here to set the record straight. Unlike so many of you, I couldn’t be prouder of my representative, Jim Banks, for sticking to his guns and ignoring reams of empirical evidence, the will of the voters in his district, and the overwhelming concerns expressed by insurers, physicians, and hospitals. There are so many unfounded criticisms of the AHCA that I don’t have time to address them all, but here are a few.

First, you’ve got people like Warren Buffet who criticize it for lowering his tax bill. Sure, he’s insanely wealthy and would become even wealthier if this bill passes. But can you really trust a guy who would turn down getting more money in his own pocket? I mean, what I’m most worried about is lowering the tax rate Donald Trump will be paying on all the money he’s making on the side while he's President, and whether Barack Obama will be able to keep a bigger cut of his $400,000 speaking fee. Why would anyone think that providing healthcare could be more important than these folks getting to keep more of their money?

And what Mr. Buffet seems to miss is the point of putting more money in his pocket and other rich people’s pockets. By giving the wealthy and corporations tax breaks, this will give them more capital with which to create jobs. Sure, this kind of effort has failed to create jobs time and time again (with some narrowly defined exceptions). But we can’t let that past experience and empirical data get us to abandon our ideological commitments. We’re faced with a choice, people: we can either get a slim chance of more jobs at a time of relatively low unemployment or we can keep in place a system that is successfully providing health insurance for more people, particularly the poor. This is a pretty easy choice. 

"... We can't let that past experience and empirical data get us to abandon our ideological commitments. We're faced with a choice, people: we can either get a slim chance of more jobs at a time of relatively low unemployment or we can keep in place a system that is successfully providing health insurance for more people, particularly the poor."

Second, others worry that the AHCA removes coverage for pre-existing conditions and will automatically raise rates for “high-risk” (read: costly) individuals while simultaneously removing yearly and lifetime caps. That’s not true. What the AHCA does is allow states to request waivers to do this sort of thing. And this is a really important distinction. First, it allows Congress to say, “See, we didn’t do it. The states did.” If there’s one thing Congress excels at, it’s avoiding accountability for its actions. Second, it reminds us of the important axiom that we are not all Americans. We’re Hoosiers and Illini and Ohioans. It’s not proud to be an American. It’s proud to be a Hoosier. Third, it protects every state’s right to sacrifice the health insurance and well-being of its (poor) residents for the pocket books of the wealthy and the profit margins of companies. And if the poor people in a state don’t like that decision, they should spend the money they don’t have to move to another state. 

Third, some say that putting the health insurance of millions of Americans at risk will undermine our claim to be a land of opportunity. They claim that limited access to health care will limit the opportunities of the poor, the disabled, and the ill. But, as an Alabama representative so rightly pointed out, these folks are poor or disabled or ill because of the poor choices they’ve made. If they didn’t want to be in these positions, they should have made better choices. In support of this point, I always like to remind people of Keith Richards. Here’s a man who lived a debaucherous lifestyle by all accounts, made health-risking decisions on a routine basis for decades. And yet, he’s still alive and kicking. Which just goes to show that deep down, he must be a truly virtuous soul and that his decisions, as unhealthy as they may seem on the surface, were actually healthy ones. 

The AHCA favors large corporations over poor individuals, it ignores the long-term economic consequences of its ideological commitments, and it achieves a political goal regardless of its effects on the people the policy effects. It’s as American as apple pie.

Abraham Schwab is a Fort Wayne associate professor of philosophy and medical ethicist.

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