By Moira O’Neill

At last! With Barack Obama out of the White House and Democrats out of control of both houses of congress, we are finally in position to repeal Obamacare and end Medicaid as we know it.

The American Health Care Act, proposed earlier this week, ends more than a century of effort to make publicly funded health care accessible to all Americans. When we are done, people will be welcome to whatever health care they want, so long as they pay for it.

Within a month, and without any estimates of cost, House Speaker Paul Ryan hopes to have the bill passed and the dismantling begun. I am all for his can-do energy. But in our haste, I can’t help thinking maybe we should take a minute, set aside party loyalties and campaign slogans and have a frank conversation about what we want for ourselves and our health.

Last year as a candidate for office, I talked to thousands of people in Hancock County about health care. It strikes me that Ryan’s proposal does not represent what people told me they need. I heard several themes: Obamacare saves lives and money. Obamacare premiums are too high. MaineCare should be expanded. Medicare is great. A universal system, or “Medicare for all” would save money.

If this is how we as a community think, then we should make sure our president and congressmen know what we want.

Obamacare was designed to be “affordable” through shared cost, income-based support and increased revenue. Mandating everyone have health insurance meant we shared the cost, sick or not. This included expanding Medicaid (Mainecare) to bring more people into the pool. Income-based subsidies made it possible for folks with lower incomes to afford coverage. And we raised revenue to help pay for it by a small tax on the highest investment incomes.

So what went wrong? For many people, it worked great. I met a woman mowing her lawn who was diagnosed with late stage cancer just as Obamacare went into effect. All of her treatment was covered, and she is cancer free today. But many people, especially self-employed, were crippled by high premiums, up to $30,000 a year, with such high deductibles they were paying for health insurance they could not afford to use.

Folks with local hospitals reported accruing millions in unpaid care from insured patients unable to pay deductibles. And then there were the people who were not eligible for any insurance at all. Because Gov. Paul LePage consistently vetoed MaineCare expansion, they were left out. I did not meet anyone who complained about the tax in high investment income. Although I did knock on doors of expensive homes that suggested those incomes, the tax on investments never once came up as a complaint.

The common thread and ultimate failure of Obamacare is the prices profit-making insurance companies charge for health insurance. Paul Ryan shifted the goal from universal coverage to what he calls “universal access.” Mandates, subsidies, Medicaid and tax revenues have been stripped in the new law. Popular benefits remain: coverage for children up to age 26 and of pre-existing conditions, for example. But without the cost-sharing of mandated participation or tax revenue, how will that be paid for?

Insurance companies have dropped like flies from Obamacare, not because they were losing money, but because they weren’t making enough. To hold their profit line under the new law, they will be free to charge far more and cover far less. Everyone will have access to health insurance if they can pay for it. In TrumpCare, wealth beats health. And that is fine. Why should poor people get free or subsidized health insurance?

One reason is the preservation of three hospitals in our county. They provide critical services and are major employers. As more people lose insurance or get dealt high deductibles, hospitals will be hit hard, services will be dropped, lay-offs and worse will happen. The health care industry is the fastest growing industry in Maine, and it is about to go the way of logging.

Here is the surprise I discovered at doors around Hancock County: rich, poor, Democratic, Republican, most believed that a universal system with a single payer and low administrative costs like Medicare has would be a better option.

People still would have to contribute in some way, but taking the profit out of health insurance would surely lower costs of health care and none of the thousands I talked to suggested anyone should be denied health care.

A recent Pew Research poll found 60 percent of Americans want a universal health care system. This makes sense to me given the conversations I had with Hancock County voters last year. It’s time our elected officials start listening to the people they represent. We need a universal, Medicare-for-All system that is cost effective and fair.

Moira O’Neill of Surry is on the board of Maine AllCare, a nonprofit organization that promotes universal health care.