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Auchter's Art: Repeal and replace is a real puzzler

Jul 21, 2017

If you need some perspective for this health care madness, reporter and author T.R. Reid is a pretty good place to start. Reid is an American but has lived overseas (Japan and the UK) and also has first-hand experience with seeking medical services in multiple countries as part of his work.

Research for his 2009 book, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care, predates the Affordable Care Act, so it is an excellent resource if you have trouble remembering why the ACA (also known as "Obamacare") came to be.

One of Reid's main observations is that a country's health care system is reflective of its nature and values. So, for example, Germany has an extremely complicated public/private (yet strictly non-profit) system, but Germans are rule-followers, so it works. Canada has a single-payer system that sometimes causes ridiculously long waits for certain procedures, but Canadians are all about fairness and the system treats everybody (rich and poor) the same, so it works.

The United States, well, we all want to be winners. We want the best health care, but don't want to pay for it. This has resulted in a convoluted mix of systems — your particular flavor depends on your age, employment status, geographic location, and so on.

But beyond its burdensome expense and gross inefficiency, it's primary flaws are these:

  • The United States does not provide guaranteed health services to all its citizens (which is a problem for the poor and middle class).
  • The United States is the only major developed country where its citizens can be bankrupted by medical expenses (which is a problem for everybody except the hyper-rich).

The ACA was an attempt to solve these flaws. Repeal and (maybe) replace is an attempt to double-down on them.

To be clear, I don't believe a Medicare-for-all type system is without its own flaws. It would serve us well to acknowledge and plan for the challenges.

But can you imagine a health care system where all individuals would be free to move jobs and start businesses without fear of medical consequences? Where small and large businesses would be unburdened from the expensive diversion of administrating insurance plans? Where the state of Michigan could free its budget from the medical world and concentrate on education and infrastructure?

It's really a matter of deciding whether we want to reflect the best or worst part of our nature.

John Auchter is an editorial cartoonist. Views expressed in his cartoons are his own and do not necessarily reflect those of Michigan Radio, its management or the station licensee, The University of Michigan.