Why The Loss of Obamacare (LGBT Affordable Health Care) Should Be a Cause of Concern
At this point, it is no longer useful to express any outrage at what Donald Trump is doing. The man has successfully and skillfully broken virtually every taboo in American politics. My concern now is with health care provision for LGBTQ people. Republicans have a very bad form on this. Those who lived through the trauma of the 1980s remember how President Reagan stalled and stalled when it came to dealing with the HIV/AIDS crisis within the gay community. The sheer cost in human life and misery was unprecedented in modern history. That is not saying that the administration could have cured the disease earlier. Their fault was really in failing to provide LGBT affordable health care and support to the victims.
Of course, when you raise such issues now with GOP stalwarts, they will immediately turn back to their revisionist history that would have you believe that Reagan was the best thing that ever happened to gay people. In reality, his government ignored one of the worst health crises to ever have hit the LGBTQ community. Now they are at it again; using pretty much the same arguments as before. Being sick is a punishment from God or providence for something you have done. The government has no responsibility for your healthcare costs.
The Residual Approach to Human Welfare and Toxic Market Fundamentalism
I have never believed that healthcare should be subjected to market forces at all. My friends tell me that I am a deluded idealist because the government can no longer afford to pay for everyone when we are in so much debt. My response is that if we can afford to fight wars of attrition in Iraq, Syria, and Afghanistan; then we can afford to provide people with health services. This is particularly true for vulnerable communities such as LGBTQ people who have specific health problems that require a bespoke response. Trump knows that we will not be so docile so he has cleverly termed his healthcare vandalism as merely “minimizing the economic burden” of the Affordable Healthcare Act (Obamacare to you and me).
We know that up to 18 million Americans are going to be put into the waste bin of uninsured status the moment that Obamacare is repealed. If you consider the Medicare and Medicaid cuts, that list of the abandoned souls could rise to 32 million people. The affected communities will inevitably include LGBTQ people who are in need of antiretroviral treatments for HIV infection. It will also mean that a lot of the good preventative measures that were incorporated in Obamacare will be lost. Brace yourself for a sick American nation, and an even sicker LGBTQ community. We know there are some who would rather see us die off so that we cannot inconvenience them with our “lifestyle”. As far as I am concerned; such people are inhumane and should never be part of the policy discussion. I also reject the notion that I am some kind of conformist with tunnel vision about the costs of healthcare. Far from it; I am all for reform of Obamacare, but for very different reasons from what the GOP is presenting to us.
The Case for Single Payer or Free Healthcare
First of all; I believe that we need to offer free healthcare as much as possible. I am an admirer of the National Health Service (NHS) in the UK. I know that the Conservatives will sniff at that model because they do not have “the best doctors” like in the good old USA. In reality, the pre-Obamacare days were characterized by utter misery for LGBTQ people who could not get insurance for any number of reasons including poverty and the notorious pre-existing conditions. Trump intends to get rid of the mandate, meaning that all the healthy people can run away from the scheme.
We know how that is going to end because that it was before Obamacare: skyrocketing premiums and the loss of coverage for LGBTQ people who will retreat into the shadows of the healthcare system. We also know that Donald Trump is not really bound by any conventions so it is anybody’s guess what he actually has in store for us. To his credit, Trump has not been as virulently anti-gay as the party to which he currently belongs. Heaven helps us if it becomes open season on the gays. I know some of you are already tut-tutting about the possible hyperbole. However, the Latinos had no inkling the GOP would become so anti-them, so quickly and so completely.
The stark reality for LGBTQ people is that they could end up paying twice what they are currently paying within just a decade of the repeal. The GOP reassures us that they have a plan but it is not yet set in stone. Once again we know how that one plays out: anyone remembers comprehensive immigration reform? The GOP promised, promised and promised. When they could not deliver, they turned on the victims of the joke that is our current immigration system. That is why I am not hopeful that there will be a plan that matches any of the Obamacare achievements.
What Reform Should Look Like
Lest I am accused of being nothing more than a philosophical armchair critic, I will highlight some of the practical things that are important to the LGBTQ community.
- Continued Cost Control: We should be aiming for much, much lower premiums. Ideally, healthcare should be free but I am realistic enough to know that America is not yet ready for that drastic step. They could nevertheless introduce a system of means-tested contributions from the public. Obamacare was beginning to do that but became derailed by President Obama’s obsession with consensus. The moment that the AHA was diagnosed as not being perfect; the duplicitous GOP leaped onto the bandwagon. Suddenly they were these budget hawks who did not want to spend a cent of state funds on healthcare…yet they were more than happy to collect on their gold-plated packages. I could write a book on the duplicity, mendacity and outright corruption of the US legislature at the moment. That is a topic for another time.
- Bespoke Services for LGBTQ Communities: We know that this is a community that has been in crisis. Many members are prone to HIV/AIDS, a life-threatening condition that is chronic even with the best treatment in the world. Besides, there is a host of other conditions such as hepatitis which might affect the community. We are not happy about the lack of care and attention given to our healthcare needs. That is why we need service packages that are bespoke to us and delivered in an environment that dignifies the human condition rather than denigrating us.
- Preventative Measures: I am always puzzled as to why successive US governments have failed to grasp the simple fact that prevention is always better than curing health problems. If we had a proactive healthcare promotion program, then many of the hospital waiting lists that we are so afraid of would not exist. Demagoguery of the health issues affecting LGBTQ people is not going to achieve this result. Instead, we should be looking at community-based solutions that highlight a healthy lifestyle. I am against the interference of bigots in the provision of healthcare. That means staying away from the litmus test of “the deserving poor”. Anyone in need of LGBT affordable health care should get it regardless of their sexuality and sexual identity.
- Consumer Choice: I am not a fan of the market but I must highlight this point. The market is not the best option in my opinion because it suggests that health is a commodity (which it should never be). However, many of the people in my circle of friends argue that we must move towards market-based solutions. That means free access for entrepreneurs and competition. If I grant them that argument, then I must also point out the need for quality. Monopolies tend to reduce overall quality due to a lack of competition. That is why anything that the GOP comes up with must increase the range of possibilities for anyone that wants to improve their health.
Meanwhile, the LGBTQ Community Must Pick up the Advocacy Mantle
We have never gotten anything without a struggle. That is why we should not expect anything different when it comes to Obamacare. I must emphasize the fact that this is not about opposing Trump or the GOP for no other reason than the need to be contrary. Instead, we want to make sure that the ideas they propose will not leave permanent gaps within the community health services program. I am sure that some Conservatives who live in the rightwing news bubble will argue that the LGBTQ community gets too much consideration anyway, the implication being that they do not need any further attention. Needless to say, I consider such an opinion to be a load of nonsense.
What we need is to go out there and make the case to Trump and his advisers. We know that he very much likes to engage with people, particularly if they can support some of his ideas. In this case, we must prepare a reasonable alternative that will not get him expelled from the GOP. The cross-state exchanges are no good because they still ignore the important aspect of affordability for the individual regardless of their circumstances. As is customary in many societies, the LGBTQ community will be at the back of the queue. This is the time for us to jump the queue and go straight to the top. If we stand back and hope for the tender mercies that Trump might throw to us; we could end up regretting the end of the Obama term much quicker than we ever imagined.