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July 20, 2017

Healthcare and the GOP

The Republican Party of Dwight Eisenhower and Richard Nixon—even George H. W. Bush, for that matter—has mutated into a purely ideological movement. That ideology, which might be labeled ultra-corporatist, is dedicated to (1) rewarding higher incomes with tax breaks, which many millionaires (and billionaires) have come forward saying are pointless, and (2) reduction and/or sabotage of government-provided services to the citizenry, manufacturing "proof" that the federal government is too big, inefficient, etc.

Readers of this blog will know I'm not being partisan. I am not a Democrat. I do not support the Democratic Party, for the same reason that, were I old enough then, I would not have supported Ronald Reagan and George H. W. Bush. Today's Democrats are basically yesterday's Republicans. We now have a Republican Party (called Democrats) and a right-wing-libertarian-evangelical party (called Republicans). The former is bad. The latter is worse.

The literature on the rightward shift of American politics is rich and detailed. Books by political scientists Jacob Hacker and Paul Pierson, analyst Thomas Frank, and others provide a handy reference to this recent history. The GOP has successfully enchanted the white working class while pursuing policies that harm the white working class. The tactics are easy and merely involve branding. Appeal to Christian piety is one. Appeal to racist hatred is another. And appeal to cowboy-movie archetypes is another. These three work like, well, a charm. Whether the recent healthcare debacle will help break the spell is hard to say, though there are signs of it.

The efforts to do away with—or "repeal and replace"—the Affordable Care Act have for now ended in failure. And this is good news for lower income people (Medicaid expansion extended coverage to about 10 million people) and those who purchase their own insurance (about 10 million). All in, about 20 million people now have insurance that didn't before. Think the population of Romania or Taiwan.

But the ACA, or Obamacare, is struggling. For one, not enough healthy people have purchased plans through the exchanges, which has driven up premiums and deductibles. If health insurance companies take on more sick enrollees than healthy ones, this then creates greater expense for the provider. The simile of an all-you-can-eat buffet has been used to illustrate the point: the success of a buffet depends on many customers not eating very much. If, however, the preponderance of your clientele are sumo wrestlers, your smorgasbord will likely go under.

However, the GOP has also contributed to market instability. Republicans in both houses have worked very hard—it's interesting to note when they are willing to roll up their sleeves and put in overtime—ensuring that if they can't nullify Obamacare, they will at least do it maximum damage. Trump continues to promise doing what he can to monkeywrench the individual mandate and cost-sharing subsidies (see also here). According to CNN Money: "The uncertainty surrounding the mandate and the subsidies is responsible for up to two-thirds of the 2018 rate hikes, according to consulting firm Oliver Wyman in a June report."

When ideology is placed above all else, this is what one gets. The "conservative" priority is to erase the memory of Barack Obama and his "liberal" legislation by causing chaos at the expense of those who are vulnerable. Members of Congress make a base salary of $174,000 and enjoy heavily subsidized health insurance. The mistreatment of those with little by those with much, it is worth mentioning, is not particularly Christian and contravenes the basic white-hat ethos on display in cowboy movies; racist hatred, of course, remains unperturbed in this scenario. Simply put, what the GOP is doing is not in any way conservative; it is vicious and morally indefensible.

The future of the ACA is a question mark, but it seems here to stay for the time being. As I've mentioned before, it is not a great healthcare system, speaking from experience. But after seven years of attempting and failing to rid the country of an improved system, the GOP could opt to help upgrade the ACA. Choose instead the path of "refine and reform." They did it in the early 2000s with Medicare.

Making the system better would not be hard in the least. Raising subsidies, for a start, would help increase enrollment and lower premiums. For an extensive list of improvement strategies, see Charles Gaba's blog, which I have found helpful.

A vote to repeal only (and replace later) still looms in the Senate next week, though it doesn't appear the requisite 50 GOP votes are in place. Republican senators Susan Collins (ME), Lisa Murkowski (AK), and Shelley Moore Capito (WV) have said they won't support repeal without replacement.

Should the repeal-only vote also fail, it is anyone's guess what will be next. Fortunately, we have a lot of say in the matter. Moving forward will require us to think outside the partisan confines in which Capitol Hill—and the healthcare industry—would prefer us remain.

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