Who knows what will happen with the Republican Senate bill to eliminate the Affordable Care Act and replace it with a plan of their own? We have been told that the congressional recess for this holiday weekend gives voters the opportunity to weigh in on the issues. Social media and other media outlets have been sprinkled with updates on confrontations with Senators and Congressmen and Congresswomen. On the Fourth, these will likely be interspersed with pictures of parades and bunting. And with commentary about a president whose asinine tweets about Morning Joe and CNN are an embarrassment to that office and our nation.

As I listen to the arguments in the public debate over health care, however, this is what I am looking to hear, but rarely do:

• Calling the Affordable Care Act Obama Care is a cipher that uses racism to undermine anything accomplished by the 44th President of the United State, Mr. Obama, a pragmatist whose administration constructed a mechanism to improve health insurance coverage for tens of millions of people without dismantling a system that is hell bent on surviving at all costs.
• The Republican plan at this point proposes deep cuts to Medicaid coverage and reduces or eliminates taxes that have helped provide this coverage. While this particular issue of tax breaks for the wealthiest 1% is among the most visible in advocates’ arguments against the current Senate bill, it is incredibly incomplete. The Republican party overall and its right wing in particular have long been shaping public opinion against Medicaid. Indeed, the term Medicaid Expansion has been viewed by many as synonymous with welfare state.
• U.S. citizens are so uninformed about Medicaid and Medicare that they cannot seriously be expected to know what to do in the voting booth.
• Republican’s so-called cost-saving measures have absolutely nothing to do with actually saving any costs. They are actually transferring costs to individuals and to states.
• In the process of transferring health insurance costs to individuals and states, the Republican Senate bill will likely actually increase costs because the real beneficiaries of their plan (read: pharmaceuticals, medical equipment purveyors, insurers, construction companies, electronic medical records developers) will harvest dollars faster than ever, unobstructed by the already very limited federal oversight.
• In their endless pledge to eliminate the Affordable Care Act, the Republican Party leaders never bothered to develop a reasonable alternative that would actually provide insurance coverage for people in our country. Then, behind closed doors over the course of a few weeks, they negotiated a new plan that would further replace the concepts of care, coverage, access, and profit with their underlying value of abject greed.
• The threatened and actual departure of some large insurers from the market place in several states has been as much a political play as anything. While bringing in billions in profits under the Affordable Care Act, insurers have argued that they are not profitable. That distortion has gone undisputed by both political parties.
• At the heart of the major flaws of the ACA is the premise that health care coverage must rely on extraordinarily profitable ventures called insurance companies. A major reason — certainly not the only one — that the Affordable Care Act seems less affordable is insurers who feel a need to post bigger and bigger profits.
• Many beneficiaries who are opposed to the ACA are also distorting reality and confusing their feelings for fact. I know someone who bitterly complained that his family health care coverage had gone up $30K under the ACA. Only later did I discover that $5K was the result of his vastly increased coverage by extending benefits to his young adult children — one with a pre-existing condition — and the remaining $25K was in a savings account that he established to assure he’d have ready cash should his deductible need to be tapped. It was still his money and under his control.

Describing the Affordable Care Act or any Republican alternative to it as a health care bill is inaccurate, misleading, a myth, and a lie. These are health insurance bills that can and do profoundly affect access to health care services, but — to paraphrase the old Saturday Night Live sketch called Coffee Talk — they are neither health nor care. Our public discourse on health care coverage lacks some basic content related to availability, accessibility, and acceptability. In many places in the U.S., there is surplus health care, services that are not needed or are underutilized. Advertising hospital services, medications, or diagnostic technology in a competitive market place — all of this reflects excess availability. Conversely, basic services are frequently unavailable in other areas, especially if theses areas are poor, rural, or unpopular for some other reason.

Health care is generally viewed as acceptable in the U.S. By this, I mean that, when surveyed, large percentages (80+%) of health care patients state that they are satisfied or very satisfied with most aspects of their care. Room temperature and hospital food choices remain their greatest grievances. Of course, these surveys suffer from a huge selection bias. Responding to these surveys assumes you were able to access the available health care services in the first place. If you don’t make it in the door or if there is no door to enter, there is no opportunity to complete a survey.

The ACA was specifically intended to increase access to health care services by extending insurance coverage through a combination of private pay, increased numbers of Medicaid recipients, and provision changes in existing health insurance coverage that would include more people with more health care challenges (e.g., insured through age 26, no penalties for pre-existing conditions). This hybrid plan had at its core a problem. It relied on good will from insurers who lack it. In seeking to greatly increase access, our former president underestimated greed and overestimated basic human respect.

Current Republican proposals are essentially falsehoods because they do not intend to increase access to health care services, but rather to limit access for those who cannot afford it. Their subtext for this is the myth that insurers are benevolent, the aged/poor/disabled are worth less, and greed is a virtue.