How many GOP presidential candidates know how the U.S. health-care system works? Or what the Affordable Care Act does? In October, one-time Republican candidate Herman Cain declared that if he had been diagnosed with stage-four cancer under "Obamacare" he'd be dead -- because government bureaucrats would have prevented him from getting the necessary treatment. Of course, Cain completely misunderstands the Affordable Care Act. He's not alone.
On Friday, December 2, Rick Santorum paid a visit to a group of New Hampshire high-school students, and offered the following lesson on the U.S. health-care system: "There's a reason that people who don't have health insurance right now, who want to sign up for health insurance are stopped from getting insurance on a preexisting condition," Santorum said. "So if you have cancer, and you're not insured...then you want to get health insurance, right? Because it's really expensive [to get cancer treatment]. Imagine if the government said you can get health insurance, and the insurance company can't deny you because you have cancer."
Santorum asked the class if anyone disagreed with that, and one student spoke up: "Wouldn't that drive the insurance companies out of business?" "If you don't have to have insurance until you're sick," Santorum explained, "why buy insurance?... How much would insurance be if only people who needed insurance bought it? The whole point of insurance is: healthy people buy it, sick people buy it, and those who are healthy support those who are sick.... But if insurance is only sick people buy it, well guess what's going to be the cost of insurance. That's why there's a preexisting-condition clause."
Has Santorum been paying attention to the health-care debate? Does he have the slightest idea what the health-care law he's promised to repeal actually does? Until the Affordable Care Act was passed, insurance companies could dump customers when they became too expensive. They could deny you coverage if you admitted to having a "preexisting condition" -- in English we call this "illness" -- or if they determined that you had been keeping one from them. The Affordable Care Act ends those practices. That is why the law requires everyone to have health insurance -- so that insurance pools are not filled mostly with expensive sick people. And that's why insurance companies have come around on the law -- they are about to get a lot more customers. (Read about one cancer patient's experience with the interim government Preexisting Condition Insurance Plan here. "For me it's been a lifesaver," she writes. "Perhaps literally.")
Santorum seems to understand the concept of insurance -- everybody pools resources so individual customers can be covered when the need arises. He even grasps the problem with a health-insurance system in which the sickest patients drive up costs for everyone. "You're not going to see health-insurance rates go down...unless you have the consumers involved and purchasing the ordinary maintenance of them just like the ordinary maintenance of your car." (For now, pass over his ill-considered comparison of health insurance with car insurance; he conveniently ignores the fact that while not everybody gets into major car accidents, nearly everyone will become expensively ill.) What he's just described is the signal achievement of the Affordable Care Act. Not only does the law bring coverage to millions of uninsured Americans. It also lowers costs across the health-care system.
Recently, Santorum has been openly discussing his three-year-old daughter's illness, a rare and very serious chromosomal condition called Trisomy 18. "I had insurance under my employer," Santorum told the students. "And when I decided to run for president, I left my job, I lost my insurance, I had to go out and buy insurance on the open market. We have a child who has a preexisting condition. We went out and we said, we left this plan, and we want to join your plan. Fine, we have to pay more because she has a preexisting condition. We should pay more. She's going to be very expensive to the insurance company. That cost, while not the whole cost, is passed along to us.... I'm OK with that."
You know what else the Affordable Care Act does? It bars insurers from denying coverage to children with preexisting conditions. Right now. Before the bill was signed into law last year, a parent in Santorum's position could find his child denied coverage because of a preexisting condition. Is he OK with that too? Because if the Affordable Care Act is repealed, that's precisely the situation parents like him -- though mostly not former U.S. senators -- would find themselves in.
