{"id":17571,"date":"2017-05-12T07:19:05","date_gmt":"2017-05-12T13:19:05","guid":{"rendered":"http:\/\/lastbestnews.com\/site\/?p=17571"},"modified":"2017-05-12T07:19:05","modified_gmt":"2017-05-12T13:19:05","slug":"opinion-the-unspoken-crux-of-the-health-care-debate","status":"publish","type":"post","link":"https:\/\/montana-mint.com\/lastbestnews\/2017\/05\/opinion-the-unspoken-crux-of-the-health-care-debate\/","title":{"rendered":"Opinion: The unspoken crux of the health-care debate"},"content":{"rendered":"
\"Bruce<\/a>

Bruce Lohof<\/p><\/div>\n

Seven years after the passage of the Affordable Care Act (ACA) and more than six months after the election of a repeal-and-replace majority in Washington, the health care quarrel remains unresolved. And now it\u2019s leaking into Montana\u2019s special congressional election.<\/p>\n

Here\u2019s why. Most Montanans believe in universal health care; many of them don\u2019t want to admit it, though, and most don\u2019t realize that they\u2019re already paying for it.<\/p>\n

Let me explain.<\/p>\n

Folks on the left advocate universal health care. They\u2019ve done so since well before Rob Quist\u2019s 2017 congressional campaign. The position is easy enough to understand: access to health care is best\u2014and at lowest cost\u2014provided universally. Think of libraries, roads and parks, fire and police departments: call them public goods defrayed by public funds.<\/p>\n

For folks on the right, folks like Greg Gianforte, health care has always been a private good, best provided\u2014and competitively priced\u2014by the market. Think of customers (who are patients) who purchase products (an appendectomy, for example) from providers (clinics and hospitals, nurses and physicians).<\/p>\n

Customers of means receive their products on demand and pay their providers in cash. The less affluent are wary of the cash-and-carry risks; they maintain health insurance that kicks in as-and-when. ACA alters this equation only by making health insurance more affordable.<\/p>\n

The Republican alternative to the ACA, the American Health Care Act, which has passed the U.S. House and faces an uncertain future in the Senate, would alter this equation again, mainly by making health insurance less<\/em> affordable.<\/p>\n

\"CapreAir_Variable\"<\/a><\/div><\/div>But there is a Third Customer. Folks in this category (a) can\u2019t afford the cash-and-carry strategy, and (b) can\u2019t afford or don\u2019t qualify for or haven\u2019t bothered to buy health insurance. Sooner or later, of course, an automobile accident or diabetes or stage-four cancer lands them in a hospital\u2019s emergency ward.<\/p>\n

There they receive care, often of the too-little-too-late variety. The costs are nevertheless considerable. And they are defrayed by the hospital and passed on to Customers One and Two in the form of higher prices for services rendered. Which, of course, is how most Montanans pay for the universal health care that they don\u2019t believe in.<\/p>\n

Listening to the health-care debate, you get the impression that it\u2019s about the ACA, with universal care folks on the left, and the AHCA, repeal-and-replace, marketplace folks on the right. Actually, the ruckus is about the Third Customers. On the left is the conviction that universal care should\u2014and would\u2014take care of them; on the right is the conviction that it wouldn\u2019t\u2014and shouldn\u2019t.<\/p>\n

But then, too, on the right is the confession that accident victims and stage-four cancer sufferers mustn\u2019t be left to die in the streets or in their beds. While on the left is the conviction that marketplace strategies, played to their logical conclusion, dictate exactly that.<\/p>\n

Forget the debate between Obamacare and repeal-or-replace. The Third Customer is the unsolved piece of the puzzle. In the remaining days of the congressional campaign, folks should ask Greg Gianforte and Rob Quist whether they\u2019re thinking about the Third Customer.<\/p>\n

Bruce A. Lohof is a native of Montana. A former professor and a retired diplomat, he lives in Vienna and in Red Lodge.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Seven years after the passage of the Affordable Care Act (ACA) and more than six months after the election of a repeal-and-replace majority in Washington, the health care quarrel remains unresolved. And now it\u2019s leaking into Montana\u2019s special congressional election. Here\u2019s why. Most Montanans believe in universal health care; many of them don\u2019t want to […]<\/p>\n","protected":false},"author":76,"featured_media":17572,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3864],"tags":[148,5844,335,5612],"class_list":["post-17571","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-opinion","tag-affordable-care-act","tag-american-health-care-act","tag-greg-gianforte","tag-rob-quist","prominence-category-featured"],"_links":{"self":[{"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/posts\/17571","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/users\/76"}],"replies":[{"embeddable":true,"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/comments?post=17571"}],"version-history":[{"count":1,"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/posts\/17571\/revisions"}],"predecessor-version":[{"id":17573,"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/posts\/17571\/revisions\/17573"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/media\/17572"}],"wp:attachment":[{"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/media?parent=17571"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/categories?post=17571"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/montana-mint.com\/lastbestnews\/wp-json\/wp\/v2\/tags?post=17571"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}