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Dear Group, Nationally we stagger, punch-drunk from issue to issue, taxes, DACA, tariffs, MeToo. The list goes on. We need to come back to this: Cathy McMorris Rodgers and “movement conservative” ideology is plain wrong and out of touch on many things, but nowhere are they more wrong than in the application of their ideology to health care in this country. On February 21 I sent out the email I’ve copied below. I present it again today to remind us how unpopular McMorris Rodgers’ efforts to repeal the Affordable Care Act were and still should be. This issue should be front and center on our way to November. CMR’s Ideology and the Myth of Free Market Health Care Here in these United States we spend more than $10,000 per year on health care on average for every man, woman and child. Canada and the United Kingdom each spend per capita less than half that per person. In spite of spending less than half as much per person than we do, health outcomes in Canada and the United Kingdom are better than ours. Yes, in Canada you might have to wait, but in Canada people with diabetes have access to treatment. They don’t have to make a choice between getting treatment and feeding their families. They don’t have to neglect their disease for fear of bankruptcy, go blind, and wind up on the Canadian equivalent of Social Security Disability. While Cathy McMorris Rodgers remains in office this WILL NOT CHANGE. Why is that? It is because McMorris Rodgers has drunk the Republican/Libertarian Kool-Aid. Contained in that Kool-Aid is the absolute conviction that the free market solves all problems and that all government social programs are inefficient and foster dependence. Facts that don’t fit her mind frame of Libertarian ideology bounce off–if they reach her at all. At a “Coffee With Cathy” in April of 2017 I brought up the Canadian experience. Her response was pure Republican/Libertarian framing: She asserted that Canadians come down to the United States in droves to get procedures done in the United States on account of endless waits and rationing. Spokane is a major medical center close to the Canadian border. I told Ms. McMorris Rodgers I practiced for 28 years doing ocular surgery, quite a lot of it urgent and emergent. I told her that in those 28 years I operated on just one Canadian patient. I told her that I have many Canadian friends, and that all of them speak well of the Canadian health system. There was a brief blank stare in response, a tiny gap before she pivoted to another angle. Was that the moment my reality bounced off her frame? I’ll never know. Did McMorris Rodgers carry this inconvenient fact with her as a result of our meeting? No. On May 4, 2017, she enthusiastically voted for and cheerled the American Health Care Act, the AHCA, aka Trumpcare. There was nothing in that bill that was aimed at reducing the per capita cost of health care or even a glimmer of recognition that other countries have great health care systems that cost half of what we spend. Instead, the AHCA would have moved us further away from national systems. The Republican House AHCA…proposed major reforms relative to current law (ACA) that would substantially reduce the number of persons covered, moderately lower the budget deficit over a decade, reverse the tax increases on the top 5% (mainly the top 1%), dramatically cut Medicaid payments (25-35%) that benefit lower-income persons, and expand choice by allowing lower quality insurance to be purchased at lower prices for the young and middle-aged. Wikipedia Notice the earmarks of Libertarian ideology. McMorris Rodger’s AHCA cut taxes on the rich (a basic tenet of her faith), lowered total government expenditures over a decade (which she later enthusiastically gave to corporations and the already wealthy by voting for and cheerleading the Tax Scam Law), and cut money out of a social program, Medicaid (another of her fundamental tenets of faith). Would it lower the per capita cost of health care? NO! It pretended to lower cost by expanding “choice” (a fundamental talking point), in this case, the “choice” was to buy inadequate insurance and expose oneself to medical bankruptcy. Oh, yes, there is one McMorris Rodgers talking point about lowering the actual cost of care. What is it? “Encouraging competition by increasing transparency.” Really? The patient is going to lower the per capita cost of health care in the system by shopping around for the cheapest lab test or MRI? That isn’t just unrealistic, it is absurd. A very few patients equipped to critically evaluate quality and willing to spend the time might bargain for the best deal in this market, but that is a tiny minority. You won’t find Trump or Charles Koch bargaining for a cut rate MRI. They’ll hire the best physician they can find to get the best MRI…and damn the cost. The folks with the least time (working two minimum wage jobs) and in the most dire circumstances (presenting with a neglected and now acute problem) certainly are NOT going to “shop around”. What make-believe planet do these free market true believers live on? McMorris Rodgers’ slavish devotion to free market ideology blinds her to reality. The unfettered, unregulated free market is the bedrock tenet of the “Republican cause,” the cause for which she hones the sales pitch. Health care in this country is ridiculously expensive because it is not and never will be a “free” market. No amount of pontification by Paul Ryan, McMorris Rodgers and the Freedom Caucus will make it so. Pretending that free market principles will lower cost in a for-profit environment is a delusion from which McMorris Rodgers is incapable of recovering. Our country’s problem with health care cost will not be solved while McMorris Rodgers is in office. Her ideological frame prevents her from understanding. Send her home. Keep to the high ground, Jerry |