Saturday, December 31, 2016

All the King's Horse and All the King's Men Couldn't Put Humpty Together Again

Back in Obama's heyday, his opponents had an angry accusation they made about him.  They said that he and other Democrats were wild-eyed radicals who didn't care what electoral price they paid for it, they just wanted to "fundamentally transform" the country away from what conservatives loved.

And let's face it.  They were right.  Sure, initially they didn't recognize just how fierce the opposition to Obamacare would be.  And once that became clear, they trusted that when it started covering people, it would become popular.  And when even that didn't happen, they took comfort in the thought that no matter what electoral price the Democrats paid, it would be worth it for bringing health insurance to so many people.  Because Republicans wouldn't actually strip 20 million people of their health insurance.  Would they?

My guess is that when Republicans set out to destroy Obamacare, and maybe more, they may be making the same calculation.  One saw it already in their attempts to defund Planned Parenthood.  In many poor and rural communities, Planned Parenthood was the only provider of women's healthcare. And no, many of them didn't provide abortions (although they did make referrals), but provided birth control, STD treatment, Pap smears and the like.  A defunding threatened to shut down healthcare networks that took decades to build.  Which means that if Republicans did manage to defund Planned Parenthood, the communities that lost their women's health clinics wouldn't be getting them back again, even if Democrats later restored funding.  Victory!

Now imagine if Republicans start out by defunding Planned Parenthood and bringing down access to women's healthcare all across the country.  They then repeal Obamacare, promising to replace, but dithering and never reaching an alternative and the system crashes.  Some 20 million people will lose their health insurance.  Victory again!  Even if the resulting outrage means that Democrats take the House, Senate and White House in 2020, they will have only two years to clean up the mess before the midterm elections.  Then, at the midterms, Republicans can run against Democratic ineptitude in failing to clean up their mess in two years, retake at least one house, and block any future action.  Even further victory!

Many people have warned that if Republicans repeal the financial aspects of Obamacare without undoing its regulations, the result will be that private insurers have to cover sick people for the same price as well people and the whole individual health insurance market will be destroyed, on or off the exchanges, and some 30 million people will lose their health insurance.  I am confident that Republicans genuinely do not want this result.  The individual health insurance market, after all, was, until Obamacare, essentially unregulated and therefore, in libertarian eyes good, indeed, ideal.  But nonetheless, Republicans may find crashing the individual market an acceptable piece of collateral damage if it creates an even bigger mess and makes it even harder for Democrats to clean it up.

Add to that Republicans turning Medicaid into a block grant to states and gradually defunding it, and privatizing the VA just as the private healthcare market is crashing with unknown results on the healthcare industry in general,  Plans to turn Medicare into a voucher system will have an interval (ten years, in most versions) before taking force.  If Democrats win in 2020, they should be able to save Medicare at least, but as for the rest, all the king's horses and all the king's men couldn't put Humpty together again.

I am not suggesting that Republicans actually want to strip millions of their health insurance and destroy the current system of paying for healthcare.  The would assure me, no doubt sincerely, that all they want is to get government out of the healthcare business.  Stripping millions of their health insurance is purely an accidental and unwanted side effect of reducing the size and scope of government.  And no doubt they trust that once you take government out of the picture, the magic of the free market will cause a better system to spring up in the long run.

But still, it remains true that it is easier to destroy than to build, whether government or private actors do the building.  And even making the most optimistic assumptions about the long run, in the long run, after all, we are all dead.  And if you strip millions of their health insurance, with who-knows-what effect on the healthcare delivery system as well, the long run could arrive a lot sooner for a lot of people than it otherwise would.

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