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About this blog: The Raucous Caucus shares the southpaw perspectives of this Boomer on the state of the nation, the world, and, sometimes, other stuff. I enjoy crafting it to keep current, and occasionally to rant on some issue I care about deeply...  (More)

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“Give Me Liberty AND Give Me Death”?

Uploaded: Mar 27, 2017

It’s hard to know what Patrick Henry would make of the new conjunction in the headline. My good friend John (who often upgrades these columns) suggested it for this edition -- it’s his apt description of the ill-fated GOP alternative to the ACA/ObamaCare. That phrase also captures the essence of the fundamental health care dilemma Americans have had to resolve.

You see, you can have freedom from government intervention in this failed market sector, but it comes at a steep cost in human suffering and lives lost – one that the country appears to be no longer willing to tolerate. It took longer than I’d expected for the ACA to command majority support. It also required the creation of a stark contrast between ObamaCare, warts and all, and the best alternative the GOP could muster. The prospect of that replacement approach focused attention and drove the country into the arms of the previously maligned option.

Sometimes, you don’t know what you’ve got ‘til it’s (almost) gone.

There was much discussion in the intense, if remarkably brief, Congressional debate over who was on the side of ‘mercy.’ Speaker Paul Ryan called repeal an act of mercy, although it’s not clear from his quote whether he considered it legislative euthanasia, or whether he claimed to be releasing ACA sufferers from their government bondage. In response, Congressman Joe Kennedy was quick to invoke scripture to label the expulsion of some 24 million Americans from health insurance coverage as anything but ‘merciful’ in a Biblical sense.

Frankly, they both got it wrong. Insurance, after all, is not a function of mercy, but of community. It spreads risk among those covered, who have thrown-in together to blunt the impact of unknown, but foreseeable catastrophes. While it’s true that the ACA burden weighs more heavily on the healthy and the wealthy, the embedded assumptions are that each such status is temporary, the future is uncertain, and we’re all better-off if we have a system that includes, and benefits everyone in the society.

That’s what the GOP bill never understood. Republicans do ‘get’ how much they hate taxes and government, so their bill started out as a familiar, massive tax cut for the richest Americans, whose burden of ACA-related taxes would be lifted. Their bill would also ‘free’ the healthy from that ACA mandate that everyone must ante-in to the insurance kitty. They hoped for an expedited vote before the non-partisan Congressional Budget Office could tally the toll their bill would necessarily take. That 24-million/27,000 lives lost estimate made it clear what the rush was all about; community-minded citizens were aghast, and opposed to the bill in large and vocal numbers (it finished with a whopping 17% approval rating from the public).

On the other side, the GOP’s rock-ribbed ‘freedom caucus’ votes were necessary to achieve a House majority. They began to demand changes that would’ve further eroded the bill’s tenuous nature as insurance. They secured amendments that removed coverage for maternity care, mental health and other costs (‘tis said that chemotherapy was out, but aromatherapy survived). After all, the reasoning went, why should men and those who do not believe they’re mentally ill have to pay for others to receive such care?

The answer, of course, is that that’s exactly what insurance does. If you end up permanently indestructible, such that all you get for your premiums is peace of mind, well – lucky you. Otherwise, you’re better off being covered – often life- and fortune-savingly so, but usually not immediately.

Those amendments rendered the GOP offering anathema to everyone else. Essentially, you could carve that turkey of a bill in ways that covered more or fewer people and conditions, and gain or lose individual votes accordingly. But no matter how you sliced it, you could not command a majority – even within the ruling GOP. Fundamentally flawed ideas are sometimes like that -- the bill was withdrawn to avoid a certain formal defeat.

So, what’s it all mean? Several things in the short run: Speaker Ryan, whose intellectual development was stunted by an infatuation with Ayn Rand, has (finally!) been exposed as a lighter-than-air policy wonk. Le Petit Orange, for all his vaunted bargaining skills, had his bluff called - twice - within his own Party in two days. When he switched to appeasement, it was never enough. That’s Some negotiating prowess. It is also clear that he never understood even the rudiments of the internally doomed bill he was touting as wonderful – fabulous – the best. His savvy, hard-bargainer rep and credibility have taken a big hit – Huge. His approval rating as I write this has dipped into the mid-thirties% .

In the longer run, it means that Americans have looked at the choices and the math – financial and medical – and have concluded that as between freedom from the ACA’s dictates and coverage for ourselves and millions of our fellow citizens, we’ll take the coverage. Health care has thus cemented itself as a right, rather than a privilege. For that reason, as well as the amply-earned current embarrassments noted above, ObamaCare is now pretty safe from fundamental attack.

It remains to be seen whether the vanquished will ignore, or try to hamstring the law administratively to self-fulfill their currently unsupported ‘imminent failure’ prophesy. Some folks are even suggesting that Trump should ally with Dems to improve the ACA -- as his best route to getting the Righties in his party to toe the line in future partisan controversies. That would be a strong move by the Prez, and good for the country; I’m guessing it won’t happen.

Finally, no one should lose sight of the fact that medical prices, and therefore insurance premiums, are rising independent of the poorly-named ACA – not because of it. ObamaCare is about coverage, not cost. Hospital prices are opaque and outrageous, and consumer choice/shopping is impossible, even for elective services. The market has failed to serve the public, and reform is needed. That’s a very big fight for another day.

Comments

 +   1 person likes this
Posted by Jake Waters, a resident of Birdland,
on Mar 27, 2017 at 9:20 am

Jake Waters is a registered user.

Tom, you said: "ObamaCare is about coverage, not cost." I wonder if you have Obamacare? Fortunately, I don't have to have it, knock on wood. I really believe President Trump should push it aside and allow it to implode, explode, and eat itself. It will in time. Anything, and I mean anything run by the government is destined to fall apart.


 +   10 people like this
Posted by Tom Cushing, a resident of Alamo,
on Mar 27, 2017 at 9:58 am

Hi Jake: thanks for your comment. Couple things -- yes, I had an ObamaCare policy bought through Covered California before I 'graduated' to Medicare. I don't think I owe anyone further details, but it worked for me as a reasonably healthy, self-employed individual.

I recognize that part of the fear-based tactics of the GOP alternative was the prediction of impending catastrophe, whether by implosion, explosion or death spiral -- all good panic-laden terms that suited their partisan purpose. Problem is that there's not much evidence to support those claims. Both the CBO Web Link and BrookingsWeb Link provide convincing evidence of market stability. Those are reliable sources. No kaboom.

As to the generalization about government programs, Medicare, Social Security and Defense would be three easy examples of programs that have worked well, forever. Someone is always predicting demise because: government, but it just ain't necessarily so.


 +   2 people like this
Posted by Cholo, a resident of Livermore,
on Mar 27, 2017 at 10:22 am

Rep. John Lewis: Web Link

Hi Jake...CHEERS!


 +   1 person likes this
Posted by Jake Waters, a resident of Birdland,
on Mar 27, 2017 at 8:27 pm

Jake Waters is a registered user.

@Tom

Good for you that the experience was positive, but time will tell, and I am not confident it will stand the test of time. As for your bias, remember, the Democrats do their fair share of fear mongering as well.


 +   3 people like this
Posted by rosalindr, a resident of San Ramon,
on Mar 28, 2017 at 12:04 am

rosalindr is a registered user.

Ah Medicare. I've been on Medicare for almost 10 years now. Who says Gov run health care doesn't work? Not us seniors.

When my car was T-Boned in 2013 by a kid running a light on Bollinger Canyon Road, I wound up in the hospital for three days with four broken ribs. My Medicare and supplementary insurance covered almost all of the costs.

Oh, you say, why didn't the kid's insurance pay? Well they did, but two years later after I had my lawyer sue him. In the intervening time, my medical care was covered.

So even in a case where I was not responsible for my injuries, I did not have to come up with megabucks to pay for my medical care.


Roz


 +   7 people like this
Posted by Tom Cushing, a resident of Alamo,
on Mar 28, 2017 at 7:56 am

Hi Jake: you've repeated your concern that the ACA will surely fail, but you haven't linked or cited any evidence.

There ARE ways for the Administration to try to undermine the law: here's an article from today's NYT that describes what's already been done since January in that regard: Web Link Rattner is a pretty good source -- he had a lot to do with the resurrection of the auto industry, circa 2009.


 +   3 people like this
Posted by Dave, a resident of Danville,
on Mar 28, 2017 at 3:35 pm

People forget that many types of insurance started out as mutual aid societies (note the word "mutual" in the names of several insurance companies, even today). They were collectives composed of members of a community who recognized that pooling their individual risks by sharing the costs, creating a fund, and making sure that the few unlucky participants who suffered a loss would avoid financial ruin. And these societies were designed as non-profits. It was only in this century that many of them were converted into for-profit entities, where the goal became making a profit (even if it meant unfairly/illegally denying or delaying payment on claims), and excluding those who might have a higher risk.

Private, for-profit businesses are a great economic engine in this country. But, there are some essential services -- like insurance -- where they don't always serve the public well.



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