Saturday, June 24, 2017

And Again on the Healthcare Front

Needless to say, much of the reasoning in my previous post applies to healthcare as well.  Why are Republican so determine to pass a wildly unpopular bill that strips 20 million (or so) people of their health insurance; raises premiums for older consumers (a highly Republican constituency); allows insurance companies to offer skimpier plans, possibly pricing essential services out of the reach of people with pre-existing conditions; and allows the return of lifetime limits?  People on my side assume that it is so they can repeal the taxes that fund Obamacare and that stripping so many of their insurance is purely incidental.  I am not so sure.  I can see many motives similar to the ones I proposed for repealing measures that would allow regulators to keep a failed bank from setting off a general financial crisis.  So here we go again.

Economic royalism.  Republicans are convinced that the unregulated free market is perfect and that if we just get government out of healthcare (including regulating insurers) all will be well.

Ideological principle.  This is much the same thing.  Someone I read (don't remember who) commented that Republicans have opposed government paying for healthcare long before they became committed to tax cuts at the top.  They blocked Truman from creating a national health service along the British model.  They resisted Lyndon Johnson's creation of Medicare and Medicaid. They spiked the Clinton plan (Hillarycare, they called it).  It is not exactly a secret that Republicans see entitlements in general (Medicare, Medicaid, Social Security) as constitutionally and morally illegitimate and would like to get rid of them.  Up till now, any sort of rollback has not been politically feasible.  Republican, having excited so much outrage against Obamacare, now finally see the opportunity to roll part of the welfare state back.  They are taking it.  Not only does the plan take away insurance from people who gained it under Obamacare, it puts a serious squeeze on Medicaid. If they succeed and don't pay too high an electoral price, Medicare and Social Security just might be next.

Pure partisanship.  Obama was responsible for a program that extended health insurance to 20 million people.  That program must die because Obama originated it.  Real world consequences take a back seat to partisan spite and "winning."  (I am pretty sure this is Trump's motive).

A warning to future Democrats.  I always thought that part of the goal for Republicans in fighting Obamacare was to make the subject so toxic that Democrats would never touch it again.  Actually repealing it and stripping 20 million of their health insurance serves the same purpose even more strongly, and in at least three ways.  First of all, it may leave the Democrats too exhausted to go through the whole process of creating a healthcare system all over.   Second, it may create such a mess as to make such attempts futile.  And finally, it makes that point that even if Democrats are successful in cleaning up the mess Republicans make, it will be an exercise in futility, since Republicans will just take a wrecking ball to whatever Democrats create.  I confess to not being clear why having a large uninsured population is such an important principle to Republicans, but it is time to acknowledge that it is.

Winning future elections.  Finally, making total hash out of the healthcare system may cost Republicans the election in 2020, but fear not.  It seems most unlikely the Democrats will be able to clean up whatever mess the Republicans leave by 2022.  And then Republicans can make Democrats' failure to clean up their mess a big campaign issue.

Maybe this last is overly cynical, but just look how Republicans managed to crash the economy in 2008 and then run against the Democrats for not having fixed it yet in 2010.

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