Sunset Of The American Dream

The United States is often called a nation of immigrants. Many of our families made the choice to leave their homes and make the arduous journey to a land that promised a better life, if not for them then at least for future generations.  A better life for some meant the right to practice their religion without government interference.  The American Dream included food for the hungry, prosperity for the impoverished, and freedom, a concept so alien that most could not define it, for all.

The American Dream is under attack.

Security. The American Dream is dependent on us feeling secure.  Secure in our faith in the rule of law.  Secure financially with a stable economy. Secure with access to quality health care paid, for the most part, by someone else.  Yes, someone else.  Most Americans have private self-paid health insurance, employer sponsored group coverage, Medicaid for the poor and working poor, Medicare for the disabled and elderly, or some combination of a couple of those.  This is hardly a perfect system, but it is ours.  Tampering with our process of compensating medical providers should only be done with the goal of improving the system.  Someone needs to explain that to the Trump administration.

The Trump Justice Department is actively trying to sabotage the Patient Protection and Affordable Care Act (Obamacare).  A main feature of the PPACA is the protection the law provides for those of us (about 52 million Americans under age 65 according to the Kaiser Family Foundation) who have preexisting conditions.  Unsatisfied with the destabilizing impact of removing the penalty associated with the Individual Mandate, the Justice Department has upped the ante and asked a district court to open the door to medical underwriting.   Donald Trump believes that we should return to the days when unhealthy people were charged more for their health insurance.  Denying coverage can’t be far behind.

This blog predates the PPACA by over a year. The Patient Protection and Affordable Care Act was a compromise bill created by Republican and Democratic lawmakers.  It both suffers and benefits from those compromises. But it was still being drafted right up to the vote and this blog has been clear that the PPACA was poorly written and much, too much, was left in the hands of the regulators.  This blog is neither defending the law nor the process.  But, our system was working to adjust to the changes initiated by the law.

There have been two types of Republicans since the passage of the PPACA, those who understand the nature of the law and cynically campaign and fundraise against it, and those who really don’t understand our health care system.  There was never been a comprehensive Republican alternative to Obamacare.  But the Republican tax bill that eliminated the penalty, as of next year, for failing to carry insurance, Trump’s decision to eliminate funding for the Cost Sharing Reduction, and this new effort to reduce access for Americans with ongoing health issues, usher in the era of Trumpcare.


Trumpcare                                                                              Obamacare

Erase a legacy                         Goal                                        Access to care

Destabilize                              Markets                                  Adjusted in time

Price based on health             Underwriting                         Community pooling

Short term politics                  Vision                                      Focused, if flawed

Guaranteed to fail                  Success                                   Needed to evolve


Some states are trying to stave off the disaster of Trumpcare.  Governor Phil Murphy (D-NJ) and Governor Phil Scott (R-VT) have recently signed legislation that will codify the Individual Mandate in their states.   New Jersey has also passed legislation that will take the money raised by the penalty to form a reinsurance fund to further help stabilize the market.  Several other states are reviewing similar actions.  Ohio, this being an election year, is marching in the opposite direction.

I cannot sit silently and watch the American Dream being attacked. How much worse it is when that attack is from within?


Picture – David L Cunix – Sunset Of The American Dream

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