Trumpcare Is Not the Health Plan We Need (but Neither Is the ACA)

This week, the Senate's plan to gut the Affordable Care Act and Medicaid was reviewed by the Congressional Budget Office. The verdict is that 22 million more people would lose their health insurance under that plan. Compared to the bill in the House of Representatives, under which 23 million would lose their coverage, at best you could say the Senate version is only 95.8 percent as terrible.

So where does this leave us? If the Senate manages to pass its bill, (the vote has been postponed until after July 4) the immediate effect would be a return to the pre-Affordable Care Act period but with even higher prices for medical care and with average wages that have been stagnant for decades. If the GOP plans go nowhere, we've still got the ACA, and that's not a lot.

The truth is that the country's social safety net has been getting more tattered each year. Under the GOP plans, most Americans, working or not, would have less (if any) insurance coverage. The steeper penalties for the uninsured included in the Senate bill would be just another insult added to the injury of medical care being generally unaffordable even now.

Here's what I'm talking about: In 2015, a Kaiser Family Foundation poll found that 20 percent of all American adults with insurance had difficulty paying their medical bills. In 2016, the portion of people having trouble paying rose to 29 percent. On top of that, 43 percent of those responding had trouble meeting their deductibles, and about one-third reported the same about paying their premiums.

These are people with health insurance.

Crowdfunding for medical emergencies may be a desperate act, but it's not an efficient way to raise money.

Our solutions for these sorts of endemic problems are ad hoc at best. Consider this from last week: NerdWallet found that of the $2 billion raised by GoFundMe campaigns since 2010, nearly half of it was to pay for medical expenses.

One friend of mine has used GoFundMe for medical expenses three times--the first time in 2014 for emergency surgery, the second time in March 2016 when she was hospitalized for a seizure, and the third time three months later, when she was seriously injured in a car accident.

She lost months of work. She also is the only employed member of her household, which at the time of her illnesses and accident included two children, her retired father, and a disabled sister.

Crowdfunding for medical emergencies may be a desperate act, but it's not an efficient way to raise money. She only raised $5,600 out of the total $10,500 she was seeking in all three campaigns.

Across the board, crowdfunding has a rather low success rate. GoFundMe hasn't disclosed how often campaigns raise all the money they set out to, but among other companies, Kickstarter (which funds artistic or entrepreneurial campaigns only) had a success rate of just 35.8 percent as of June 26. Another study found that was by far the best rate among other platforms.

For decades, health care has been a business first and a service for the common good second.

Even if GoFundMe has a higher success rate than that, all those medical campaigns are competing for attention, both against other medical campaigns--how do you weigh one person's CAT scan against another's car accident against another's chemotherapy?--and millions of other artistic, entrepreneurial, or charitable campaigns.

Some of them are worthy causes and predisposed to success: The cute kid who raised $90,000 for his father's kidney transplant in just a week was already internet-famous as the baby in the "success kid" meme. Then there are people like the guy who raised more than $55,000 to make potato salad. (You can find him on your own.)

For decades, health care has been a business first and a service for the common good second, so in some ways it makes sense to look at it from that perspective. We and our illnesses are all a bunch of energetic startups seeking our first (or second, or third) round of funding. This metaphor falls apart quickly, however: Startups dealing with the equivalent of stage 4 cancer seldom have that kind of energy.

Where do we go from here?

Making health care policy is hard, something everyone except President Trump already knew. President Obama's ACA was a kludgy adaptation of a Republican state plan ramped up to a national scale with a few carve-outs to keep the insurance industry on board and to sway the votes of moderate Republicans. It was a far cry from the single-payer option progressives hoped for, but it more or less worked and was salvageable.

Despite the ACA's market-based elements, Republicans turned on it and the Trump administration has been using its executive powers to undermine it. The only silver lining to come out of a repeal of Obama's bipartisan solution is that the next attempt at serious health care reform may be the single-payer system, or something close to it that still covers everyone and controls costs. It's going to be a long road back to a Democratic Congress and White House, but perhaps when we get there, they can finish the job.