Ok look, now I know I may not be as smart as a
member of Congress, either in the Senate or the House, but I seriously don’t
understand why it is that the Republicans seem so determined to make this
entire “repeal and replace” process regarding Obamacare so difficult. I saw Paul Ryan on Fox News last night and
all he kept repeating, nearly ad nauseam, was how the Republicans are keeping
their promise to “repeal and replace.” I
can only assume that he thinks we’re all too stupid to recognize that what’s
currently being offered is nothing more than smoke and mirrors. And I’ll tell you right now, if what we’re
seeing now becomes a reality, then come 2018 Ryan will no longer be Speaker,
McConnell will no longer be leading the Senate and the Republican Party will be
returned to the status which they seem to be much better suited. Now either these guys think we’re bluffing or
they simply don’t care, but either way the American people will have their say.
And so here we are, seven long years later, years
spent listening to these same Republicans continue to make the same promise to
“repeal and replace” Obamacare. And
after years of waiting for them to come up with what we all hoped would be
viable plan to do just that, what do we get?
We get a bill from House Speaker Paul Ryan which, for all practical
purposes, is even worse than Obamacare!
Seriously? And when you stop to
think about it, it’s a rather impressive feat because, in their pursuit of a
lower score from the Congressional Budget Office (CBO), Democrats made
Obamacare just about as bad as they thought they could get away with while
still calling it “universal” health care.
While many other analyses are focused on how Ryan’s American Health Care
Act will make life worse for certain lower income Americans compared to Obamacare,
pointing out the similarities is more important for understanding its politics.
Under Ryancare, most people will get coverage
through their employer, just like with Obamacare. And in both cases, many of the poor will get
coverage through Medicaid. And with both plans, lower/middle income people without
employer coverage will be encouraged to use tax credits to help buy ‘regulated’
private insurance. Neither Obamacare nor
Ryancare has any real price control measures to deal with our dramatically
out-of-control healthcare prices. Both
plans leave groups of Americans without insurance they consider to be ‘affordable’. Finally, both are heavily “financed” by a
Cadillac tax on expensive employer-provided insurance that is delayed for a
decade, resulting in no one expecting the tax to ever go into effect. There are four major areas where Ryancare
does differ from Obamacare, but even here, most of Ryancare’s provisions are
only a bad funhouse mirror version of very similar Obamacare policies. They are:
1)
Medicaid: The most important difference
is that Ryancare will change how the Medicaid expansion works and is funded
starting in 2020 by freezing enrollment and creating a per capita cap, which
places funding limits on each person. Of course, that might never happen. If
the GOP doesn’t feel comfortable implementing these changes now, I don’t know
how they think it will be easier in the middle of a presidential election. This Medicaid cut will cause about 4-6
million people to lose Medicaid coverage, according to S&P (which I need to
cite since there is no CBO score).
2)
Tax credits: The second most important
difference is that Ryancare will, in 2020, replace Obamacare’s age/regional
based, means-tested, refundable tax credits to buy private insurance with
age-based, sort-of-means-tested, refundable tax credits to buy private
insurance. On the plus side, the more
modest means-testing design in Ryancare means the tax credits should be
slightly easier for the government to administer, will make insurance more
affordable for some Americans who currently make too much to qualify for
Obamacare credits, and somewhat addresses the issue that means-testing created
a big effective marginal tax on lower income people. The issue is that Ryancare’s “fixes” the
problem created by Obamacare only providing lower income Americans enough tax
credits to make insurance affordable by basically making tax credits equally
insufficient for everyone. And since they aren’t pegged to the cost of health
care, the Ryancare tax credits could become less sufficient every year.
3)
Individual mandate replaced by late enrollment penalty: Ryancare gets rid of the deeply unpopular
individual mandate. In its place, it imposes a late enrollment penalty that’s
supposed to nudge people to buy private insurance in a timely manner. If you
fail to buy coverage for awhile, you will need to pay 30 percent more when you
do buy insurance. Both systems suffer
from the basic flaw that they don’t make insurance truly affordable for
everyone but punish you if for some reason you feel you can’t make your premiums.
Obamacare has hardship exemptions for the mandate, though.
4)
Taxes repealed: Finally, Ryancare
repeals almost all of the other Obamacare taxes, meaning it probably won’t pay
for itself. Repealing the Obamacare taxes on the rich will likely be viewed by
many as being nothing more than just a big giveaway to the rich.
Ryancare is not a change of structure from
Obamacare. It’s a change of scope. The
big similarities, and the fact that even the differences are more a matter of
size than radical policy redesign, completely undermines the GOP’s ideological
and political position. It’s not based around a coherent theory for what is
wrong with health care, nor does it offer any big new ideas to fix our
problems. By comparison, there are
intellectual theories behind how plans like the old Wyden-Bennett bill or
Medicare-for-All could improve conditions with big system-wide changes. There is no principle or story behind
Ryancare to explain how, even in theory, it could make things better. There is
no reason to even hope it could make things cheaper or coverage better. There
is no way to look at what is really nothing other than a worse version of
Obamacare and not conclude that it would have an impact similar to Obamacare.
So now Republicans are left trying to explain why
they kept claiming Obamacare was such a terrible existential threat that it can
be completely fixed by cutting rich people’s taxes and making it less generous
to some people in need. As a result, the
ideological Republicans aren’t happy, the more pragmatic Republicans who would
need to implement it aren’t happy, the non-partisan groups aren’t happy, and
even the political hacks don’t know how to sell it. The Republican PR team is honestly left
pointing to the fact that Ryancare has fewer pages as being proof that it’s
better. Selling Obamacare was almost
impossible for Democrats; selling what is really nothing more than an even
worse version of Obamacare should prove even more difficult for the Republicans. Frankly, I don’t understand why it is that
the Republicans seem so determined to make things so much more difficult than
they need to be. A lot more
difficult!
And I’ll tell ya something else, the Republicans are
going to have one chance, just one, to get this thing right, and while Ryan may
think he’s being pretty clever, the truth is, he’s not fooling anybody. Personally, I think Ryan, like most
politicians, is pretty lazy, hence is recent and lame justification regarding
the eight day work schedule planned for the House next month. And while Ryan may think he’s pretty cute, I
think most folks realize that he’s doing little more than trying to appease his
big donors in such a way that will allow him to claim he tried his best to keep
things as close as possible to the original Obamacare. At least he can say, "See I tried to
keep it as the establishment wants, but that's just not going to
fly". His big donors can't say he
didn't try. I think Ryan has known all
along that this rendition was never going to pass the smell test. So now let’s move forward with a serious
attempt to “repeal and replace” and leave this attempt behind.
If the GOP insists upon pushing millions of poorer
Republican voters, who rely on Medicaid so they can get medical treatment and
survive, off of Medicaid, the GOP will surely lose its present majority
position in government and the mantra of “Make America Great Again” will be
relegated to bumpersticker status in much the same way that “Hope and Change”
was. It's called cutting off your nose
to spite your face, I think.
Alternatively, we can replace Obamacare and move on to accomplish a
hundred other important tasks that need to occur in order for “Make America
Great Again” to become a reality. The
stars will never again align like this in our lifetime. If Republicans blow this opportunity the
“Make America Great Again” is dead and the Democrats, like the Phoenix, will
rise again. And America will go into
steep socio-economic and moral decline while the borders are thrown wide open
and our civilization declines.
Those who now seem to be so determined in their effort to shove through what is nothing more than a soup sandwich do so not only at their own political peril, but it also places at risk the future of our country. Because their continuing opposition to this new Americanism will most assuredly destroy this country just as quickly as the regressive left in this country will. Republicans need to focus on getting the job done, and done right, while keeping the promises that were made so that we can then move on to trade, taxation, immigration, and a hundred other things that are now, after eight years of Barry “Almighty”, in urgent need of being addressed! Come on people, it’s just not that freaking complicated. And if a simple old soul like myself is able to recognize that fact then why is it that those in positions of power seem to be so freaking mystified by the entire concept of doing what it is that they promised and in the way that they promised to do it!
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