It now seems that some Republicans don't even believe in the concept of insurance, whereby resources are pooled and risk is spread among a large group of people who all pay into a pot that helps out those who get sick, or whose house burns down, etc.
As an example, one Republican member of the House Energy and Commerce Committee seemed incredulous that the cost of prenatal care for pregnant women was included in the premiums that men pay for health insurance.
Aside from the fact that pregnancies do not occur without at least some participation by men, there is the basic concept of insurance, Jonathan Cohn and Jeffrey Young, writing in the Huffington Post, characterize it as: "the idea that people will pay into the system when they are not using it, so it's there for them when they are." We all pay for some services that we don't use. Women's premiums help cover the cost of prostate cancer treatment, for example. We all share in paying for someone else's cancer treatment, while hoping we never get cancer ourselves.
Compare another type of insurance: homeowners fire insurance. Most people's houses never catch on fire. But you want to have the insurance (and your mortgage contract requires it) so that you're covered for this huge expense if it ever does happen. If you were to self-insure for house fires, you'd need to permanently set aside hundreds of thousands of dollars you may never need, just so you can replace your house if it ever does burn down. Only the very wealthy can afford to do that. For everybody else, we have insurance.
It's called cooperation. It's not socialism, as some extreme right-wingers want to call it. There's also the argument that we all benefit from living in a society that takes care of its most needy and most disadvantaged. I would not want to live where that was not a shared value. [See Joe Kennedy III's eloquent statement on this in yesterday's ShrinkRap.]
In trying to sell his health care replacement plan, Speaker Paul Ryan used inflammatory rhetoric that emphasized the point of view of those who oppose "entitlements" and the whole concept of social contract. As reported by Cohn and Young, Ryan said: "The whole idea of Obamacare is that . . . the people who are healthy pay for the people who are sick. It's not working. And that's why it's in a death spiral."
That is such a distortion. First, what he derides as the "whole idea" is actually the concept of insurance -- spreading the risk. Second, Obamacare is not in a "death spiral." There are two main reasons premiums have gone up: (1) health care costs have risen, but less rapidly than they did before Obamacare; and (2) Republicans have created such a sense of uncertainty in what is going to happen that insurance companies are hedging their bets, in some instances pulling out of markets, and in others raising their rates exorbitantly.
Ryan is equally dishonest in what he promises from his plan, explaining how it would stop skyrocketing premiums and collapsing markets, so Americans can "enjoy universal access" to health care. How do you square "15 million will lose their Medicaid health care" with "universal access to health care." Make Ryan explain that.
The answer of course is that the most efficient and the least costly method of providing health care insurance for all people is the government-run, single payer, universal health care. We are the only developed nation that does not have some version of this. And most of them work pretty well. But it is anathema to Republicans, who have made "socialized medicine" a term of horrified opposition for decades. It is also fought strenuously by the insurance companies and pharmaceutical companies.
As Cohn and Young conclude: "The ultimate goal for Ryan and his GOP allies isn't to guarantee health care and financial protection from medical bills. It's to minimize taxes, especially taxes on the rich, and to let the free market operate with as few regulations as possible. That's a perfectly defensible choice for extreme conservatives . . . But it reflects a very particular set of priorities and values -- and perhaps not one a majority of American share."
I wish this could be just an abstract debate about the role of government, but it's being fought out over real people's actual lives. With Republicans in power, we seem headed back to a Golden Age for the wealthy, a disappearing middle class, and a growing lower class who barely make it. The wealthy are increasingly enclaved into gated communities, protected from contact with the masses and their diseases and their sniveling brats. Push them away, let them suffer . . . and die. Under Ryan's plan, the government won't care either.