Friday, June 30, 2017

McConnell's Monster

Like a movie monster that keeps rising from the dead long after you think it has been dispatched, the American Health Care Act, and the Senate's sequel, the Better Care Reconciliation Act, simply refuse to die.  And also like movie monsters, if they are released from the laboratory into the world, they will main and kill thousands of innocent people.  The numbers change from week to week, but the latest CBO estimates are that 22 million people will lose health coverage under the latest Senate proposal, 32 million under the President's latest repeal-then-replace proposal.  Many of those people will fail to get necessary medical care and, as a result, some of them will die.  These are the facts, accepted by both sides.

Given this gruesome truth, one has to wonder why the Republicans are so hell-bent on getting this monstrous legislation passed.  Polls show that fewer than 10 percent of Americans support the AHCA/BCRA.  In a rational, democratic country, that would be the end of it.  No legislation could possibly survive that kind of unpopularity.  Alas, we do not live in a rational democratic country.  We live in an oligarchy, increasingly controlled behind the scenes by a small wealthy elite who wield enough power to get what they want despite the will of the people.  And what they want is tax cuts.

Tax cuts for the wealthy are really what the AHCA/BCRA are all about.  When the Affordable Care Act (the ACA) a.k.a. Obamacare was passed, it came with tax increases to help pay for subsidies which allow less wealthy people to afford insurance.  In particular, the ACA raised taxes on long term capital gains from 15 to 23.8%, and raised taxes on income above $400,000 per year from 35% to 39.6%.  This new tax burden fell almost exclusively on the rich, and the rich didn't like it.  So they started to write checks to Republican politicians who promised to repeal Obamacare.

And then something unexpected happened: Donald Trump won the presidency, and suddenly the Republicans actually had the power to do what they had promised to do, which meant that they had to face an inconvenient truth: Obamacare was actually a pretty good piece of legislation (and, it should be noted, it was originally a Republican idea).  It could certainly be improved, but compared to what it replaced it works quite well.  It's easy to forget that before Obamacare came along, if you had to buy an individual health insurance plan you were pretty much screwed.  Oh, the insurance companies would happily take your money if you were healthy, but as soon as you got sick they would drop you like a hot rock.  If they didn't drop you outright, they would raise your rates to the point where you could no longer afford the coverage.  One way or another, getting sick in the U.S. before 2013 without access to group rates was a one-way ticket to bankruptcy.  Without government mandates -- on both sides of the transaction -- individual health insurance is a scam.

So now the Republicans are in a serious bind.  They promised their rich donors that they would repeal the Obamacare tax hikes, but there is no way to do that without pulling the health-care rug out from under tens of millions of ordinary Americans.  That is why Mitch McConnell negotiated the BCRA in secret and tried to ram it through the Senate in less than a week: he was hoping he could get this done before anybody noticed the he is unleashing a monster.

The AHCA/BCRA is a metaphorical monster, but it is going to cause real non-metaphorical pain and suffering.  It will actually kill real people.  And it's going to do that so that rich people can be richer.  If you're not OK with that then the next time a Republican tells you that Obamacare is a disaster, ask yourself: are they saying this because it's true, or because they have been given marching order by someone whose pockets are deeper than their sense of moral and civic duty?


Unknown said...

Ron, your final sentence has the exact truth: Republican Senators have been given marching orders by people who value dollars over lives. The Senators' obedience proves what spineless, unprincipled cowards they are.

Don Geddis said...

"It will actually kill real people. And it's going to do that so that rich people can be richer. ... moral and civic duty"

I'm certainly not a fan of Trump, and this "repeal and replace" goal is a joke of pandering politicians, not an honest policy direction.

But, that said, you don't seem to be having an honest conversation yourself. You're demonizing your opponents, and turning a policy debate into a moral issue, with "good" and "evil", ad hominem attacks, and propaganda for your "side".

I wonder if you've even attempted to engage in an ideological Turing Test on the policy drawbacks of the structure of Obamacare.

To me, your use of moral language here is a symptom of the larger problem with US politics today. Political opponents don't engage with each other, and instead every battle is a zero-sum war of "our side" against "theirs". And you seem to be doing that here, yourself.

Ron said...

@Susan: Thanks.


I believe that health care *is* a moral issue. I believe that letting people die (destroying habitat for memes) for the sole purpose of allowing rich people to get richer is morally wrong.

> I wonder if you've even attempted to engage in an ideological Turing Test on the policy drawbacks of the structure of Obamacare.

I specifically said that Obamacare could certainly be improved. If I thought there was any hope that a rational policy discussion might lead to actual improvements being implemented I would happily engage in that discussion. But I don't think that there is any such hope at the moment, and so engaging in (or at least trying to initiate) that discussion seems like a waste of time.

But OK, this would not be first time I've tilted at a windmill: the fundamental problem with Obamacare is that it did nothing to control costs, and so it did nothing to address the real underlying problem. The reason costs are high is that the government has put in a lot of protectionist measures to keep competition out of the U.S. markets (licensing requirements, FDA approvals, patents, prohibition on importing drugs from overseas, etc. etc. etc.)

The trouble is that high health care costs allow rich people to get richer, which is what the Republicans really want, so they won't do anything to address the problem. Bernie Sander's called the Republicans' bluff on this back in February and they folded like a cheap newspaper: