Repeal, Replace, Regress

My upcoming newspaper column:

Freedom’s just another word for no health left to lose. So says Doctor Republican Congressman Michael Burgess of Texas, regarding numbers of people with healthcare coverage: “If the numbers drop, I would say that’s a good thing, because we’ve restored personal liberty in this country.” Wow. And lest you think the Republican plan for replacing The Affordable Care Act is right around the corner, Trump has had an epiphany: “Nobody knew healthcare could be so complicated,” quoth he. 

The statements provide clarity regarding Congress and our occupant of the Gold House, the latter of whom has repeatedly, if without specifics, called the ACA a “disaster,” falsely promising to end it on “day one”; and the former of which spent the last seven years voting fifty-five times to repeal it. That they’re only now discovering Obamacare is the opposite of a disaster for many millions of Americans, and replacing is harder than repealing, reveals much about our Congressional majority and their ability to govern. Legislating, evidently, isn’t like riding a bicycle: when you spend eight years blocking instead of producing, you stop knowing how. 

“Nobody knew.” Well, it’s undeniably true of Trump and those with whom he’s surrounded himself, and of the legislative bodies over which he holds apparently unlimited sway. Applied to those who wrote the original bill, though, and to the president who oversaw the process, it’s demonstrably false. Seven years ago, in fact, President Obama said, “The truth of the matter is that health care is very complicated.” That unstartling insight is shared by most people capable of thoughts of more than one-hundred-forty characters, and by anyone who’s addressed the subject seriously. 

Trump once promised, “We’re going to have insurance for everybody.” Everybody, it turns out, but those most dependent upon it, assuming the plans now being bandied by the band of bandits in Congress see the light of day. Tax credits and health savings accounts, the bedrock of Republican healthcare reform ideas, are a welcome tax dodge for the prosperous but of no use to people of modest means or less. Surely they recognize something so obvious. Don’t they care? Why their urgency to repeal? 

Simple: unlike Bush’s Medicare Part D, which, being unpaid-for, added to the budget deficit, the Affordable Care Act had built-in funding mechanisms, and has, in fact, lowered the deficit. But it did so by raising taxes on those most able to afford them; namely, Republican donors. Depending on income, the wealthiest stand to save tens (or, in some cases, hundreds) of thousand dollars with repeal. So let’s not concern ourselves with the millions who’ve gained coverage; or people saved from bankruptcy by lifted lifetime limits; or those having pre-existing conditions. (Or, as Rick Santorum calls such people, cheaters.) And forget about young people who had no access to coverage until allowed, under the ACA, to stay on parents’ plans till age twenty-six. There are donors to tend to. 

But let’s NOT forget reality. President Obama disappointed liberals by going with conservative-born health care reform. Naively thinking he’d get some Republican votes by doing so, he rejected the single-payer “public option” desired by the many people to his left. Predictable to everyone but Obama, that reaching out garnered exactly zero votes. Nevertheless, the reportedly liberty-crushing ACA has improved the lot of millions of Americans. 

And, yes, it’s far from perfect, because, as we’ve been reminded, healthcare is complicated. Compared to that of other Western countries, the American system is an expensive, unmanageable mess on many levels, the worst of which is keeping insurance companies between patients and providers of care, sucking money out like a failed Trump casino. (After promising otherwise, the tough dealmaker caved to drug companies on negotiating drug prices, another part of the mess.)  

Having done it for decades, I know stuff about health care. I know that insurance companies, given their business plan of collecting your money and trying not to give it back, are worse than unnecessary. I’m pretty sure any Republican ACA replacement, if they ever produce one, will leave the neediest worse off and won’t lower costs. And I know for certain that unless we get around to “Medicare for all” pretty darn soon, the system will fail.

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