We still don’t know whether the Senate Republicans will be able to put together 50 votes for Mitch McConnell’s disastrous plan to deprive 22 million more Americans of health coverage in order to fulfill a much-made campaign promise to repeal Obamacare.

But even if McConnell fails, the nation will still be left with a problem: Obamacare’s critics are not completely wrong.

The Affordable Care Act has not made health care affordable enough, which is why, even with the law in place, 27 million Americans are still uninsured.

People cannot afford to buy insurance because we have not found a way to control the cost of the services that insurance pays for. It’s the out-of-control cost of health care services, not some heartless bureaucrat, that really rations care and decides who will live and who will die.

We pay much more for our health care than do people in any other country in the industrialized world.

We don’t regulate the prices of prescription drugs. The same medicine, even if it was developed and manufactured here, costs more in America than anywhere else.


The same is true for other services. Americans pay on average $1,119 for an MRI. An Australian pays $215. As Sarah Kiff writes in Vox: “It is the exact. Same. Scan.”

And although Americans go to the doctor less often than Canadians, they go to the hospital more, probably because we avoid low-cost preventive care until we have no choice but go to an emergency room.

The Affordable Care Act has achieved some of its goals, expanding coverage to 20 million people, no doubt saving lives.

And it has lowered the rate at which health costs escalate. It is more popular today than the day it was signed, and even the Republican plans to dismantle it try to leave some of its key features in place, like guaranteeing coverage to people with pre-existing conditions.

The ACA aimed at expanding coverage among self-employed people and those who were not offered insurance at work. Most people who enrolled were eligible for subsidies, so even when premiums shot up by double-digit rates, the consumers were protected.

But anyone who makes more than four times the federal poverty limit (or $48,240 for an individual and $81,680 for a family of three) got no help and had to pay the full cost of the increases themselves.


These are the people choosing to drop coverage instead.

Escalating medical costs are a problem not just in the individual market, but also in the employer-provided coverage market, where half of the people too young for Medicare get their insurance.

According to a survey by the Kaiser Family Foundation, the average annual premium last year for employer-sponsored health insurance was $6,435 for an individual plan and $18,142 for a family. But that doesn’t tell the whole story.

As insurance premiums climb to cover medical expenses, employers have increasingly moved to cheaper plans that require more out-of-pocket spending by plan members.

So even though there has been relatively slow growth in premiums – below 4 percent a year for five straight years – deductibles have increased dramatically.

The Republican plans that have been rolled out in the House and Senate would make these problems even worse.


They attempt to lower premiums by letting insurance companies sell policies that don’t cover as much, leaving individuals to bear even more out-of-pocket costs.

Meanwhile, prices for services continue to climb unchecked.

How do other countries do it? Most of the international models exist in some form already.

Some countries have socialized medicine, like the system we use for the Veterans Affairs Department. Some countries have a government-run single-payer insurance program, like our Medicare for seniors.

Some use highly regulated private markets, much like the Obamacare exchanges.

They buy drugs in bulk and negotiate for the best price. They regulate health care the way we regulate landline phone service, water and electricity.

Mainers can be proud that both of their senators, Republican Susan Collins and independent Angus King, are outspoken critics of the repeal-and-replace plan, and would not be won over with superficial tweaks to a bill that would hurt so many Americans.

But whether or not the Republican Congress can pass an Obamacare repeal bill, Americans will still be left with the problem of escalating costs. We need Congress to take that problem on.

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