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.