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Kristof: Repeals and Delay: The GOP health care hoax

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Sunday, January 8, 2017

This week, President-elect Donald Trump and congressional Republicans began to dismantle Obamacare. They are telling Americans who feel trapped by health care problems: “Jump! Maybe we’ll catch you.”

This GOP fraud is called “repeal and delay.” That means repealing the Affordable Care Act, effective in a few years without specifying what will replace it.

If the Republicans ran a home renovation business, they would start tearing down your roof this month and promise to return in 2019 with some options for a new one — if you survived.

And survival will be a real issue. The bottom line of the GOP approach is that millions of Americans will lose insurance, and thousands more will die unnecessarily each year because of lack of care.

The paradox of Obamacare is that it is both unpopular and saves lives. Preliminary research suggests that it has already begun saving lives, but it’s too early to have robust data on the improvements to life expectancy among the additional 20 million people who have gained insurance. It is notable that an Urban Institute study found that on the eve of Obamacare’s start, lack of health insurance was killing one American every 24 minutes.

One careful study found that the Republican health care plan in Massachusetts, which was the model for Obamacare, noticeably lowered mortality rates. For every additional 830 adults covered by insurance, one death was prevented each year.

The American College of Physicians warned this week that the GOP course could result in 7 million Americans losing their health insurance this year alone by causing parts of the insurance market to implode. Back-of-envelope calculations suggest that the upshot would be an additional 8,400 Americans dying annually.

How can insurance make such a difference? I’ve written about my college roommate Scott Androes, a fellow farm boy from Oregon, who switched careers in 2003 and didn’t buy health insurance on the individual market because it was so expensive. Then in 2011 he had trouble urinating and didn’t see a doctor because of the cost.

By 2012 he had blood in his urine and finally was scared enough that he sought medical help. He had waited too long: He had stage IV prostate cancer. He showed immense courage in agreeing to tell his story — despite concern that his legacy would be an article highlighting his foolishness — because he wanted people to understand the human cost of a lack of universal insurance. He died soon afterward.

That’s the system that the Republicans are trying to take us back to. Americans spend two or three times as much on health care as a share of GDP as other industrialized countries but get worse outcomes. American children are 75 percent more likely to die in the first five years of life than British or German children, according to World Bank data, and American women are twice as likely to die in pregnancy as Canadian women. The reasons have to do partly with American poverty, and partly with the high number of uninsured.

Trump would have you believe that he will keep the popular parts of Obamacare, such as the ban on discriminating against pre-existing conditions, while eliminating unpopular parts like the mandate. That’s impossible: The good and bad depend on each other. The Trump approach would be like trying to amputate a dog’s rear end so you wouldn’t have to clean up its messes. It just doesn’t work that way.

Yes, health policy makes eyes glaze over. But focus on these two points: By broad agreement, the number of people insured will drop if Republicans “repeal and delay,” and more uninsured Americans means more Americans dying. That’s why the American College of Physicians, the American Medical Association and even conservative health care analysts have warned Congress not to repeal Obamacare without stipulating what comes next.

Republicans spent $7 million investigating the deaths of four Americans in Benghazi and ultimately found no evidence of high-level wrongdoing. Now they are rushing toward a scam that may cost thousands of American lives every year.

Nicholas Kristof is a columnist for The New York Times.

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