In late June, following a lengthy, secretive drafting process, the Senate GOP released its version of the American Health Care Act (AHCA), now known in senatorial jargon as the Better Health Care Act (BHCA) or Better Care Reconciliation Act (BCRA), but more commonly known as Trumpcare. This proposed legislation, crafted only with input from an all-male panel of 13 Republican senators, is exactly what we feared: Medicaid gutted, a return to annual and lifetime caps for insurance payouts, and massive increases in patients’ out-of-pocket costs, with insurance companies once again allowed to charge as much as they want based on patients’ health conditions and coverage for pre-existing conditions de facto eliminated for many.
This bill is a robbery, a plundering of the nation’s health by the rich. It steals the wealth and well-being of working-class Americans and redistributes billions of dollars to the wealthiest Americans, all while enriching the predatory, for-profit health insurance industry. If enacted, Trumpcare will shake down America’s sick and working people and place a death sentence on those who can’t pay.
The actual mechanics of the bill are particularly threatening to vulnerable and marginalized populations in the United States. It would remove legal barriers to insufficient coverage — in the form of high premiums, ballooning coinsurance costs, caps on coverage, and differential rates for preexisting conditions — thereby allowing companies to shift the bulk of the cost of health care onto patients, turning a long-term illness or an unforeseen emergency into a personal financial crisis. Even under the Affordable Care Act (ACA), health crises arising from such structural inequalities as environmental racism, the physical and mental strain of unequally divided labor, and the devastation of epidemics like HIV/AIDS can preclude people from accessing affordable long-term care and put already-struggling communities in an existential struggle against the health industry. These travesties would worsen immeasurably under Trumpcare.
Millions of Americans with tenuous access to the health care system already live in fear of unexpected medical expenses. These fears are warranted, particularly given that a recent study showed that 47% of Americans are unable to cover a $400 emergency expense. Many of these vulnerable populations rely on Medicaid — the expansion of which was one of the strongest reforms in the ACA — but Trumpcare’s proposed dismantling of Medicaid will leave those with the greatest need in grave danger. If Trumpcare comes to pass, millions of people will be thrown into a fight for their lives while the rich and powerful will enjoy even greater wealth and influence. The bill is, without exaggeration, pure, sinister barbarism.
For the vast majority of Americans enrolled in private health insurance (either through their work or the ACA exchanges), the U.S. health system is already a labyrinth of stress, frustration, and anxiety — fear that the next doctor’s bill could be the one that breaks the bank. Crowdfunding for medical costs is a troubling trend that is rising rapidly, with websites such as the for-profit platform GoFundMe processing billions of dollars in donations for medical treatment (all while charging a percentage-based fee for themselves). In our current system, a successful campaign can keep a struggling family afloat, but, as shown by the widely-reported death of Shane Boyle after his GoFundMe for a month of insulin fell $50 short (to mention just one horrific example), a failed one can mean death. Pleas for aid for surgery, chemotherapy, and treatments for chronic diseases are themselves symptoms of a deeply broken health system — one where the average family can’t afford a surprise thousand-dollar expense, but opaque rules governing coverage can lead to an out-of-network misstep costing several times that. The ACA, though its protections have contributed to a decrease in medical bankruptcy filings since its enactment, has not been able to stop the U.S. health system’s decline into obscenity.
But, rather than fix its failings, Trumpcare will simply destroy the few protections and cost controls that allowed the ACA to actually help people, all while casting millions more — 22 million, by the Congressional Budget Office’s estimate — into the eldritch horror of being sick and uninsured in America. This is no thought experiment. This horror of being sick and uninsured — or, just as likely and often just as bad, underinsured — will happen to someone you know. Any number of minor or treatable or preventable or survivable conditions will plunge a family into debt and poverty. It may be a broken leg, a bike accident, HIV, hepatitis, heart disease, cancer, renal failure, or diabetes, and it will be no fault of the person who falls ill, but it will bury that person and their family in debt for the rest of their days. This will be the reality of the American experience under Trumpcare.
We must do everything in our power to stop this law from being passed, but, thinking to the future, we must also recognize that defending the ACA’s unacceptable status quo is not enough. California Assembly Speaker Anthony Rendon’s decision to stall SB 562, the Healthy California Act — a bill proposing a single-payer, Medicare for All style system in California— demonstrates a sadly familiar lack of will from the Democrats, who offer tired excuses while promising us the world, always at some point further down the line. Passing and implementing SB 562 was always going to be a long process. But by stalling our project in California, Rendon demonstrated that, like the congressional Democrats who danced and sang for joy that Paul Ryan’s version of Trumpcare passed the U.S. House, he is willing to gamble on maintaining or worsening the status quo for political gain. Americans want a single-payer system, but insurance industry cash keeps key legislators from acting on our behalf, and the Democrats’ reluctance to engage with voters to address the failures of the ACA continues to cost them elections while costing us our lives.
A single-payer system is a practical necessity and a moral imperative, both as a means for guaranteeing universal health coverage and as a foundation on which to build a health system that prioritizes human well-being over the profit motive, and not the other way around. In many countries, the single-payer model has been in place for years and has the demonstrated ability to control costs and improve health outcomes. It would provide immediate, tangible relief to Americans whose budgets are being stretched thinner and thinner as income inequality skyrockets.
We can envision a world where human need dictates our approach to our health. Radically transformative health care needn’t begin and end at the doctor’s office or the emergency room, which under the ACA continues to be the last resort of the uninsured and underinsured. Our modern health crises are not accidents but are products of a system that exposes working people to cruel austerity while supporting the callous greed of the wealthy. Like tainted drinking water poisoning the residents of Flint, Michigan, all so unelected city managers could shave a few dollars from the budget. Or Perdue Pharma ignoring the devastation and shattered lives resulting from the abuse of its OxyContin formulations, just so it could grow its profits. Or our growing dependence on the makeshift safety net of online fundraising, relying on the kindness of strangers to fend off destitution when the health system fails us. In a just world, our health would not be something for the capitalist class to hold hostage while we labor to enrich them further. Defeating Trumpcare and enacting a single-payer system are necessary steps in creating that better world.
Matthew McGowen is a co-chair of DSA San Francisco’s Healthcare Working Group and a founding member of the chapter’s former organizing committee.