Health care is a three-trillion dollar industry that affects every part of our economy. Tracking the downstream effects of millions of uninsured people ties your brain in a knot. And then you, too, have to go to the emergency room.
This is all only to mention the medical-care system, of course. The social determinants of health—the circumstances that shape our daily lives and are the primary factors in our health, like the food we eat, the lead in our water, financial stressors, the safety we feel in our homes and communities, the visceral effects of sexism, racism, and xenophobia—these would remain and demand to be addressed. If Trump follows through with the massive tax cuts he has promised, preventive-health measures and infrastructure would narrow. This will mean only more spending in the medical system to treat problems instead of creating an environment that prevents them.
“I don't think they really want to repeal the whole thing, despite all the rhetoric,” Michael Sparer, chair of the department of health policy and management at Columbia, told me. “You've got 20 million people who have health insurance right now who didn't have it before. Taking it away from them overnight isn't something anybody is going to want to do, politically.”
There are also three million young adults who are getting care through their parents’ insurance, and millions of Americans who are benefiting from other aspects of the Affordable Care Act, like minimum benefit packages and community health centers, a long-standing bipartisan idea.
“It’s one thing to say you’re not going to help people buy health insurance,” said Sparer. “It’s another to say you’re going to take it away.”
Some of the Senators who voted for that Obamacare-repeal measure in January could have been doing it knowing that Obama would veto it, McDonough notes. These Republicans wouldn’t have to return to their electorate and explain why many people are now uninsured. Some may vote differently if and when they understand the consequences.
And there is one other player in this process—the major player, actually—the insurance industry. Pence said during a surreal health-oriented rally last week that he would protect people with pre-existing conditions. This would be the most government-heavy suggestion yet: a law that requires insurers not to discriminate, but without a law that requires everyone to purchase insurance (the individual mandate). The idea speaks to the lack of understanding on the part of the incumbent President and Vice President. The insurance industry is too large and powerful to allow this to happen.
“There are scary things that could happen,” said Sparer. “The worst case scenario for the insurance industry is the conditions that were put in place—that you can't discriminate against people with preexisting conditions, you can't have lifetime annual limits—the nightmare for the industry is that those stay but the mandate goes. That would be fiercely opposed by the insurance industry.”