Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

Following the news on the effort to repeal and replace the Affordable Care Act, euphemistically known as Obamacare, is akin to watching a train wreck in slow motion. Since I recognize this is a politically-charged topic, I feel compelled to announce that I vote as an Independent, and presently I am equally disgusted with Congress in general, regardless of party affiliation.

Being dismayed by congressional actions (perhaps inaction would be more accurate) does not make me unique as a citizen. Since 1974, when Gallup began tracking satisfaction of voters with Congress, present job approval of Congress has languished at around 15%, an all-time low.1 While I have spent a career protecting and defending the Constitution, and I have tremendous respect for our system of government, I admit fatigue to Congress’s seemingly endless partisan bickering and general failure to overcome special interests and work for the interests of the American people. The ongoing drama over Republican attempts to draft a replacement for Obamacare has been political theater at its best (or perhaps worst, if you are a fan of progress).

Just in case you have been sailing in the Caribbean (my personal plan to escape the madness someday), the following is a brief synopsis of where we stand with healthcare legislation. It is no secret that since Obamacare was signed into law March 23, 2010, Republicans have been trying to repeal or alter the law, voting more than 60 times to do so without success. The Republican nominee for president, Donald Trump, made repeal and replace of Obamacare with “something great” a major plank of his election platform. With his election and the Republican majority in both the House of Representatives and the Senate, replacement of Obamacare seemed assured. House Republicans, with no Democratic support, passed the first replacement legislation called the American Health Care Act (AHCA) on May 4, 2017. This bill, initially praised by Trump but later called “mean’ by him, had little support in the Senate or from the public. Disdain for the legislation, in part, was likely related to findings from the nonpartisan Congressional Budget Office (CBO), which estimated the AHCA would reduce the federal deficit by $119 billion but at the cost of approximately 23 million more uninsured citizens over the next 10 years. Senate Republicans took the House bill and—behind closed doors with no Democratic input—produced the Better Care Reconciliation Act of 2017 (BCRA). CBO review of this legislation noted greater savings of $321 billion and slightly fewer uninsured Americans at 22 million, although a disproportionate number of elderly, low-income Americans would enter the lists of uninsured. Backlash against this “improvement” was swift, and the Senate vote on this version of the legislation has been delayed over concerns that the Republicans did not have the votes to pass the bill unilaterally. In a final bit of irony, Senate Majority Leader Mitch McConnell noted the Republicans might have to work with Democrats to pass new healthcare legislation.

I recognize the allure of saving $119-$321 billion dollars annually in a country with a staggering debt over $14 trillion. To put the savings into something more tangible, the newest Navy aircraft carrier USS Gerald R. Ford (CVN-78) cost the American taxpayers $13 billion. The savings proposed in the various Republican bills to replace Obamacare would buy a number of new aircraft carriers. I have to ask the question though: Can the world’s richest country and premier democracy afford not to provide healthcare to its citizens? Are we really going to become a nation where healthcare is available only to the very wealthy or those fortunate to receive care as part of their employment? Is our answer to millions of American citizens, “Good luck and hope for the best?”

If you believe healthcare is a fundamental human right, as I along with the World Health Organization suggest, how can a wealthy country ethically pay for anything (including aircraft carriers) until it has figured out how to care for its own citizens?

Yes, these are all rhetorical questions, and I am blatantly oversimplifying a very difficult financial and ethical conundrum with which the United States presently is grappling. Then again, we elect representatives to the House and Senate to thoughtfully work on these complex issues and find solutions that are in the best interests of everyone, not just one political party or special interest. The rush to repeal Obamacare quickly, with anything that will fly—and with no input outside of the Republican majority for the political “win” on an issue that is fundamental to all human beings—seems reckless and stupid.

As a physician, I am greatly saddened; as a taxpayer, I am incensed. I do not profess to know nor do I have the space in this small editorial to outline all of the political and financial forces our representatives in the House and Senate grapple with daily. That said, I do not think a great statesman with cutting political insight is required to view the present congressional effort on healthcare as poor and misguided. Benjamin Franklin was a politician with almost clairvoyant political and social insight. If ever there was a time for present-day politicians in Congress to pause and take some needed advice from history, it is now with the healthcare debate. Great haste by Congress on this vital healthcare legislation will likely lay waste to many American lives.

1Blake, A. How much do people hate Congress? Let us count the ways. Washington Post. Aug. 4, 2014.