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Steve Bien is a family physician in Farmington.
In its closing weeks, the 2020 presidential campaign has been upended by the very issue that dominated at the start: COVID-19 and health care. While COVID brush fires continue to burn swathes of the country, we are witnessing a super spreader COVID outbreak that is disrupting the highest levels of our government. Even now, the president stands pat in his refusal to do the proven — distance, wear a mask and follow the science – even as this imperils the people around him.
The pandemic has thrown our national health care needs and weaknesses in stark relief. Our country should have been a model for the rest of the world in its response. Instead we have the worst COVID statistics of any developed country.
Some of this is the unconscionable lack of national leadership on this issue, but we would be wrong to ignore important lessons about our healthcare system. In the COVID outbreak and in health care generally, whether we like it or not we are all in this together. If I mask and those around me do not, I am not safe. If I have terrific health care but those around me are vulnerable and uncovered, I am not safe.
Although we are all individually responsible for making choices and taking care of ourselves, issues of health insurance and public health policy require a joint, public effort. Health insurance by its very nature requires that a large enough pool of people pay into the system so that risk and costs can be spread as widely as possible. Health insurance only works if the healthy help pay for the sick.
This is the meaning and importance of the individual mandate. The individual mandate has another key significance. It is the legal underpinning of the Affordable Care Act, and because the mandate was rescinded in the Republican tax cut of 2017 it is likely the Supreme Court will overturn it after it hears the case next month.
This should surprise no one, since overturning the ACA has been front and center on the president’s agenda since day one. But when the ACA goes down, more than 20 million people will lose their insurance coverage, including the 12 million who are part of the nationwide Medicaid expansion and 11 million in the plan’s private markets.
And then what? Once again, we would be left on our own to choose among a chaotic patchwork of offerings.
Health insurance policy is usually complicated to sort out. Not this year. One side has a plan, the other does not. It is that simple. The Republican Party did not even mention a health care plan at their convention, and they have no proposals on the floor. In contrast, the Democratic Party has a clear plan that would cover an additional 15 million to 20 million people. It calls for improved subsidies, the public option as a choice open to all, and automatic public plan enrollment for low income Americans.
We are all in this together, as the spread of COVID makes only too clear. And we have a clear choice in front of us either to move ahead towards a more fully covered, protected nation, or to move back to have us all fend for ourselves and duke it out individually with insurance companies.
We are not done with COVID-19 by a long shot, and this will not be the last health crisis we will face. Lets learn a lesson and make a smart choice.