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In our opinion: Time to tackle government-supplied health care before it gets unmanageable

In this March 23, 2017, file photo, health care professionals join hundreds of people marching through downtown Los Angeles protesting President Donald Trump's plan to dismantle the Affordable Care Act.
In this March 23, 2017, file photo, health care professionals join hundreds of people marching through downtown Los Angeles protesting President Donald Trump's plan to dismantle the Affordable Care Act.
Reed Saxon, AP

Census data now shows about 122 million Americans rely on government health insurance programs of one sort or another, a figure reported recently by the pollster

Of this, 62.5 million are enrolled in Medicaid, the government program for low income people, 55.6 million are on Medicare, which primarily serves the elderly, and 15.5 million rely on military health care plans. The total represents an increase of about 14 million people enrolled in a government plan since 2013.

Americans may not be aware of this gradual shift toward a government-dominated health care system. Regardless of how they feel about it, the shift ought not to take place without a robust public debate.

That debate seems to be happening more on state levels than in Washington. Utah’s Proposition 3, which would expand Medicaid to those who earn 138 percent of the federal poverty level, is an example.

Unfortunately, Congress appears to be too much in the grips of hyper-partisanship to hold meaningful debates that might cross party lines or involve compromises. Lawmakers prefer instead to either let the Supreme Court settle arguments or to let things drift under their own momentum.

Under President Obama, Democrats passed the Affordable Care Act with no Republican support. Under President Trump, Republicans tried but failed to repeal it. Now the marketplaces that support Obamacare are scheduled to open again in November, but experts are predicting trouble for the program.

The Trump administration expanded short-term, health care plans and Congress revoked the tax penalty for the remaining uninsured, weakening the Affordable Care Act’s supporting structure. Twenty-one states, meanwhile, have joined in a lawsuit claiming Obamacare now is unconstitutional without the individual mandate.

But while the health care act was flawed, Republicans have failed to devise a replacement plan, a fundamental part of their repeal-and-replace promise two years ago.

Americans, however, continue to believe health care is fundamentally important for a quality life.

A recent national poll found 68 percent believe it is very important for every American to have access to quality health care, with another 16 percent believing it to be somewhat important.

Also, 81 percent said they favored providing financial assistance to people too poor to afford it.

However, only 42 percent said they supported paying more for their own health insurance to make sure every American had access to such a thing. Therein lies the problem.

The Affordable Act at least acknowledged the value of market competition through its marketplace exchange concept. The danger of a government-run, universal care system is that the lack of competition and consumer choice would lead to higher costs and the rationing of certain types of care.

But the bigger the share of government-insured patients becomes, the harder it becomes for private insurers to compete for the remaining customers. With so-called baby boomers retiring, the ranks of an already financially strapped Medicare program are bound to grow. And a system that relies on third-party insurers to pay bills has little chance to bring down soaring health care costs.

So what does it all mean? The time is now to bring together a coalition of non-partisan medical and financial experts to tackle the problem before it gets unmanageable. That’s a move President Trump could push, noting the weaknesses of the Affordable Care Act and the failure of Congress to address those weaknesses.

In a nation of roughly 325 million people, having 122 million of them, or 38 percent, insured by the government represents growing costs and challenges. Absent a workable, well-vetted plan to handle costs, ensure competition and include the indigent and elderly, the nation appears destined to slide even farther into a system many people don’t want — one that continues to be expensive and confusing for consumers.