By Doug Porter
Ah, reality. The feces is about to hit the fan on access to healthcare.
After years featuring sixty-plus votes in Congress to end the Affordable Care Act, interminable misrepresentations (remember death panels?), and failing to move on even one alternative plan for legislative consideration, it’s time to put up or shut up.
There are three possible scenarios on paying for health care emerging, none of which bodes well for the more than one in three Californians covered in some fashion by Medi-Cal. All of them will enrich a few at the expense of the many by continuing commodification of what should be a public service.
The Sham Plan
President-Elect Donald Trump’s choice of George Republican Congressman Tom Price to serve as Secretary of Health and Human Services keeps the Congress from delaying action any further.
Unlike many of his colleagues, Price has ideas on what course to take. Those ideas never made it through the Congress. Now he’s got a platform like never before. This is bad news for those already sick and poor.
From John Cassidy at the New Yorker:
Under Price’s plan, insurers would still be legally obliged to offer coverage to sick people, but they could charge much higher premiums to anybody who hadn’t maintained continuous coverage—a loophole that could potentially affect millions. Sick people who couldn’t afford coverage in the regular market would be forced to fall back on special plans for high-risk people, which the federal government would subsidize. But the billion dollars a year that Price is proposing to devote to this purpose would be entirely inadequate. Inevitably, many sick people would fall through the cracks and end up with no coverage.
This example illustrates a more general problem facing Trump and the Republicans. The health-care economy that emerged from the Affordable Care Act is a Rube Goldberg contraption with many interlocking parts: laws, taxes, subsidies, public mandates, and administrative directives, along with the expansion of existing features, particularly Medicaid. Some of these pieces may have appeared to be superfluous, but they were designed to work together and support each other. If someone comes along and fiddles with one of them, such as the subsidies or the individual mandate, it can affect the entire system.
Last week, I ran into a health-care economist who used to work for the Obama Administration. She was extremely upset about the election results and about the forthcoming assault on the Affordable Care Act, and she said the one solace she could take was a political one. She would now get to watch Trump and the Republicans try to achieve the impossible: repealing, or replacing, parts of Obamacare without depriving millions of Americans of coverage and igniting a firestorm. In picking Tom Price as his point man on health care, Trump has signalled that he is willing to embark on just such a course.
‘I got this voucher for 200 dollars, but my medications cost 897 dollars, what do I do?’
‘Take solace knowing you are truly free.’
— Hank Jingle (@Hanksingle) December 1, 2016
The ‘Don’t Get’ Sick Plan
The least likely scenario is the ‘just repeal it’ plan advanced by conservative simpletons like Fox News’ Eric Bolling. (They sure like talking tough on TV.)
Confronted about 20 million people losing heath care, Fox host responds “You have emergency rooms” https://t.co/nw1G6glt6J pic.twitter.com/XnBBexaf19
— Media Matters (@mmfa) November 30, 2016
Repeal and Delay
Finally, the “compromise” scenario has come to the fore in conversations and media coverage over the past few days. It’s been touted as a way for die-hard Obamacare opponents and Democrats to save face.
Like most third way schemes, ‘Repeal and Delay’ is a trap. In addition to seemingly kicking the can down the road, discussion of such a plan never takes into consideration the complicated nature of creating replacement legislation.There was a reason why health insurance reform (which is what Obamacare really is) took hundred of pages to express, namely that every interest group in the known universe wants a piece of the action.
Within those hundreds of pages of legislation and the thousands of pages of regulations that inevitably follow are opportunities for padding corporate profits and land mines for enforcing social policy.
The certain-to-be-eliminated requirement of accessibility to birth control for women is an example of this in current law. A new law might, for instance, as Vice-President Mike Pence promoted as Indiana Governor, require burial or cremation for miscarried or aborted fetuses.
Will Democrats Do the GOP’s Dirty Work for Them?
Jonathan Chait at the New York Magazine wrote about Repeal and Delay as the ultimate scheme, one allowing Republicans to get Democrats to do their dirty work for them. This is really about 2018 for the GOP, and minimizing the consequences of their actions.
Republicans have spent six years enjoying the benefits of opposition, attacking every frustration with the status quo without owning any of the trade-offs. The sudden, unexpected prospect of facing political accountability for denying medical treatment to potentially millions of people rightly terrifies them. At the same time, enraging their base by failing to repeal Obamacare also rightly terrifies them.
So, how to get out of this trap? They need Democrats to supply the votes for a new health-care plan that Republicans can frame as a “repeal” of Obamacare. What’s more, they need Democrats to provide bipartisan cover to the invariably radioactive changes they would implement. It is likely Democrats would agree to minor changes to the program in order to secure its future. But getting Democrats to sign on to the aggressive plans favored by many conservatives, which would make basic medical care unaffordable for millions of the currently insured, Republicans need more leverage.
That’s the point of “repeal and delay.” Republicans would pass a law blowing up Obamacare’s subsidies, but with a delay of two years or so, long enough to last through the midterm elections. (Doing so would threaten to unravel the exchanges — since insurers aren’t going to stay in a system that has no future — but Republicans could probably keep it going by throwing money at them.) Then they’d argue the system is about to disappear, and force Democrats to help them put something, anything, in its place to avoid humanitarian catastrophe. They wouldn’t need to design a better system than Obamacare. They would just need something marginally less cruel than the disaster Obamacare replaced.
Let me make this perfectly clear: this scheme is about 2018 (and 2020). What we should be doing is talking about a plan for implementing single payer, not let ‘the fittest survive’.
We’ll need to keep a sharp eye on elected officials like Rep. Scott Peters buying into this BS as a way of proving his commitment to “bi-partisan solutions.”
The San Diego Congressman was a big part of delaying the income for the Affordable Care Act derived from taxing medical devices. The rationale for this stance was supposedly supporting business so it could “create jobs.” At no point was there a plan for how this revenue would be replaced.
This particular revenue stream was expected to bring in a projected $29 billion over 10 years to help finance the ACA. Meanwhile, the medical device market is projected to grow by 6.1% over the 2013-2018 period and is estimated to make to have annual profits of $44.1 billion or more by 2018.
My, what a struggling industry.
Quote of the Day, from Rep. Keith Ellison, candidate for chair of the Democratic National Committee, via Think Progress:
…I caution fellow Democrats: make your focus the American people, not Trump. We will defeat him one day, and when we do, we better have something to offer people. We need to highlight his failure to live up to his campaign promises, but we shouldn’t construct our whole lives around him.
On This Day: 1835 – Hans Christian Andersen published his first book of fairy tales. 1955 – African-American Rosa Parks refused to go to the back of a Montgomery, Ala., bus, fueling the growing civil rights movement’s campaign to win desegregation and end the deep South’s “Jim Crow” laws. 1968 – Janis Joplin made her final appearance with Big Brother & the Holding Company in San Francisco, CA.
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