Friday, March 24, 2017

Entry 373: Healthcare Again

I don't want this blog to become dominated by politics, but I write what's on my mind and politics are on my mind a lot these days, so that's what I'm writing about.

As I begin this entry, Friday afternoon, March 24, 2017, the United States House of Representatives is a few hours away from voting on their healthcare bill, AHCA (aka Ryancare, aka Trumpcare, aka Pileofshitcare).  Alternatively, they are not a few hours from voting on AHCA.  There probably aren't enough votes to pass it, so they might pull it altogether.  But Trump, supposedly, for reasons only he knows, wants to hold a vote anyway, so maybe we will have a vote.  Maybe it will even pass.  Then again, maybe they will never vote on it at all.  Nobody knows!  But even if it does pass, it will surely die in the Senate where the margin for error is even slimmer (only two Reps could dissent).  That is, unless it passes there too.  Nobody knows this either!

The whole thing is a complete and utter farce that I would find hysterical if the farce wasn't being produced by my government.  The only thing that's good about this is that it's very gratifying to watch years of Republican lies about Obamacare catch up with them.  It's like that episode of Seinfeld where George lies to his future in-laws, and they call him on it, and he keeps on lying, and they keep calling him on it, and whole thing culminates with him driving them to a house in the Hamptons he doesn't have.  As many smart people have been pointing out for a long time, a good Republican replacement bill for Obamacare is as imaginary as George's vacation home.



To see why this is the case, you first have to understand how Obamacare works.  It is held up by what some call a "three-legged stool": 1.  Laws that prevent insurers from denying coverage to citizens for, say, preexisting conditions; 2.  Subsidies that allow poor people to buy insurance; 3. An individual mandate that compels healthy people to buy insurances.  In addition, the ACA gives states federal money to expand Medicaid (which some states accepted and some (cruelly) did not), which it pays for through tax increases.

Republicans in Congress are, to a person, ostensibly against Obamacare.  But the reasons they give are not consistent with a replacement bill or even with one other.  There is a strong contingent of Reps -- The Freedom Caucus -- who object to the ACA on almost purely ideological grounds.  They want the stool gone completely.  They don't believe the federal government should have any role in providing healthcare to its citizens whatsoever.

The problem the Freedom Caucus has is that not a whole lot of other Americans feel the way they do.  There are parts of Obamacare everyday people of all political stripes really like.  Sick people like Leg 1, and poor people like Leg 2 and the Medicaid expansion.  For this reason, other Republicans have been saying they want to keep these parts.  The problem with that, of course, is these parts rely on the unpopular parts -- Leg 3 and tax increases.  If people want insurance when they are sick, then they need to buy it when they are healthy too (hence the mandate), otherwise everybody could just wait until they are sick before buying insurance, and then the market would collapse because insurers would be paying out a lot without bringing enough in.  And if we want to provide health insurance to poor people who can't afford to pay for it themselves, then somebody has to pay for it somehow.  Hence the tax increases.

For these reasons, a large faction of Republicans, most of them, in fact, have been attacking Obamacare not on ideological grounds, but for practical reasons (or for no reasons; they just disparaged it without specifics; Trump, of course, is the master of this -- "it's a disaster").  They say it's premiums are too high, that it doesn't provide enough people with good coverage, and that it could be headed for total collapse (the dreaded "death spiral"). But these are problems any replacement bill Reps propose won't and can't solve -- in fact their bill would exacerbate them -- because they would need to strengthen Leg 3 and/or raise taxes to solve them, and those are the exact parts Republicans want to trash, not bolster.  In this way, Republicans have been incredibly dishonest about Obamacare since before the law even went into effect (or they are incredibly delusional and ignorant, I'm not sure which), which is why their entire approach is doomed.

As I've said before, part of me wants this bill to become law.  Republicans would surely say I'm wrong about all this, so let's see what happens.  Let's see whose right.  But ultimately the price -- millions of people losing their health insurance -- is to high to pay.  So I hope it fails -- spectacularly.

And it does, for now, at least.  Paul Ryan pulled the bill again.  In the words of Nelson Muntz,



Until next time...


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