The 115th Congress of these United States convened on Jan. 3, and announced that Obamacare must go. It’s not that Republicans hate poor people; it’s just that poors make the money sad, and so the poors must go. The GOP is about to get rid of a lot of sick people. Where will they go? Where sick people usually go. How will the Republicans do it? Why, by repealing the Affordable Care Act, or Obamacare.
Obamacare is the most contested piece of legislation since whatever bill Florida’s legislature passed last night. Conservatives have dreamed of demolishing the ACA for several geological ages. Now with Congress loaded up with the GOP and the White House in allied hands (theoretically), they have their chance. But the problem with making a replacement for Obamacare … is that Obamacare is pretty conservative to begin with. It was designed to keep business happy, which is the primary mission of the Republican Party.
Americans have desperately needed medical reform for generations. Obama and Co. decided the best fix was to subject at-risk people to ten-week-long phone calls, an impenetrable website, and bewildering programs. It was literally neoliberalism: the program. Neoliberalism is the liberalism of the white collar class: it pretends cultural issues are the only progressive issues. Neoliberals cannot, and will not, challenge economic injustice—the chief dragon in the room. They will surrender everything before they cross that bridge. And that’s how you get the ACA: when you want to provide insurance, but don’t want to upset rich people or their businesses at all, Obamacare is what results.
The ACA insured people by funneling huge amounts of cash to insurance companies, and made the process painful to endure, at every point, in every aspect. Like medieval doctoring, the cure seemed worse than the ailment.
Blumenthal and Cohn, writing for HuffPo, said:
While the popularity of “Obamacare” has fluctuated a bit in the five-plus years since it became law, the amazing thing is how little public opinion has changed. Roughly speaking, a little more than 40 percent of Americans approve of the law, while around 50 percent disapprove — though the precise numbers vary a bit from survey to survey. The public doesn’t support repealing the law, as Republicans would prefer, and at least some people disapprove of the Affordable Care Act because they like the idea of it but wish it went further. But Americans have not wholeheartedly embraced the law, as its proponents have long hoped.
For all this, it helped people. It aided them in vast numbers. Obamacare is a small candle in a morgue, but it still throws off light and heat.
For January-June 2016, the percentage of persons uninsured at the time of interview was 8.9% (95% confidence interval = 8.35%-9.49%), which was not significantly different from the 2015 estimate of 9.1%. The percentage of persons uninsured at the time of interview decreased, from 16.0% in 2010 to 8.9% in January-June 2016.
The conservatives hate the ACA because they suspect it’s poisonous socialism. Republicans generally can’t tell the difference between socialism for the rich, like bailouts, and socialism for everybody, like the military. Ask Mitch McConnell what it is, and I expect he’d whisper that it was a dark art practiced by lesbians and librarians under the hunter’s moon, something something Karl Marx. Conservatives know as much about socialism as a teenage boy does about angina.
In fact, one of their number, Romney the Awkward, proposed a measure much like Obamacare back when he was governor of Massachusetts. Naturally, this was before he ran for President, which made it humiliating when he denounced the law in 2012, during his long march towards the ash heap of history.
Truthfully, the Republicans don’t care that most Americans both want and need health reform. Nor do they give a hoot in any of the seven hells about what comes next. Either they deliberately wish to kill off large numbers of Americans, or they are delusional. Several of them are capable of both.
What do the reptiles in Congress offer us?
Paul Ryan, the granny-starver of Wisconsin, poured out his typical patter to smooth the troubled waters. From CNBC:
“We have a plan to replace it. We have plenty of ideas to replace it and you’ll see as the weeks and months unfold what we’re talking about replacing it with — how do we get better choices with lower prices by not having a costly government take over our health care, which is causing all of these problems in the first place,” the Wisconsin Republican said.
The right wing said the same thing when they killed Clinton’s health care plan back in the Nineties; they had a decade to suggest anything at all. What did those mighty brains come up with? Nothing. How will they cover all Americans? How will they cover children? How will they stop corporations from kicking people off plans for pre-existing conditions? They’d have to fight big business to do that. That’s like asking the monkey to drag the organ grinder: a spectacle both tragic and hilarious to imagine.
Paul, my boy, what’s your plan? Private health accounts? Sure, I’ll just save up half-a-million dollars in case I need an MRI. You can tell when a man spends most of his time around really wealthy people, like when Romney offered to make a ten thousand dollar bet with Rick Perry back in 2011. They lose track of what everything in the universe costs. Ryan, Trump, the hideous ghost of Ayn Rand: these are the holy warriors who are going to decide the big questions of American health for the next two years.
Indeed, the Speaker has a long history of fantasizing on this issue. The Janesville Slasher once offered a sad little Obamacare alternative named Path to Prosperity in 2012. Path was what you’d expect from conservatives: the typical tax-break sleight-of-hand that the Right usually trots out whenever their loyalty to the country-club set becomes too obvious.
Path was a love letter to big business under the cloak of helping ordinary people. It’s odd: for a guy so obsessed with working out, Speaker Ryan never met a Wall Street bank account he didn’t want to fatten. What makes a conservative like Cut-It-All Paul so contemptible isn’t just that he’s a puppet for corporate interests; it’s that he’s so obvious about it, and in such a dumb way. Remember that Ryan is Congress’ idea of a smart guy, just as Tim Kaine is the Senate’s idea of a young person.
What will the glorious Republican health care of the future look like? One commenter, Lee The, had a compelling vision:
So RepubliCare is good old for-profit medicine and medical insurance, with insurance companies free to cancel your health insurance if you really get sick on the flimsiest pretexts with no practical right of appeal, can refuse to insure you if you have any sort of “existing condition” they don’t like (such as being pregnant), can set lifetime caps on your coverage, can charge whatever they like and cancel your policy or raise your premiums as much as they like—and when you find you have, say, stomach cancer, you’re free to shop around and pick the health insurance of your choice from among health insurance companies willing to insure someone with stomach cancer.
So much for the contributions of our friends in the Reich. What of Obama and the Ivy League, who have brought us so many bombs in so many different places? What did they contribute to the ACA? The President and the rest of the means-testing lanyards decided to surrender the public option after pressure from the insurance industry and their cabana boy, Joe Lieberman. The consumer advocate Wendell Potter, writing for Public Integrity, said:
Lawmakers were led to believe, for one thing, that insurers could be trusted to offer policies that would continue to give Americans’ access to the doctors they had developed relationships with and wanted to keep. And they were persuaded that insurers wouldn’t think of engaging in bait-and-switch tactics that would leave folks with less coverage than they thought they were buying.
Of Obama, Potter wrote, “It became clear to me as well as public option supporters in Congress that industry lobbyists had gotten to him.” Potter told Congress that if they failed “to create a public option to compete with private insurers, ‘the bill it sends to the President might as well be called “The Insurance Industry Profit Protection and Enhancement Act.”’”
After that, it was all over but the dancing, and what horrible dancing it was. What the ACA offered was not the expansion of Medicare, or an American version of the Canadian health care system. The government didn’t even give themselves power to bargain with Big Pharma. What Americans got was Ayn Rand, if she had dropped ecstasy in 1982 instead of dropping dead. Americans became wedded to health markets, enrollment periods, godawful Internet sites. Needy citizens were required to jump through a parade of hoops, each one more terrible than the last.
We are always hearing high praise for the idea of bipartisanship. We are told that the truth is somehow in the center. This is fiction. If you want evidence that “both sides win” is a terrible idea, Obamacare is a sterling example.
You can’t have it both ways. Change in politics means that someone loses. Both sides can’t always win. Power is taken, not given. If you give “everyone” what they want, it turns out, the insurance companies come out ahead. As they did with the ACA. Unless you challenge power, power remains where it is. That’s what power does.
Let’s take a trivial example from the pages of Obamacare. Have you ever called a big company’s help line, and been forced to wade through an automated call-program? I’m sure you have. We all have. Have you ever asked why it must be that way? Has it ever occurred to you that the robot system is not there for your benefit? After all, talking to a person is a much quicker way of getting the help you need. In fact, the robot system is there for the company’s benefit.
It’s messed up, if you stop and think about it. You’ve already paid for the company’s good or service. If you’re calling that line, you need help. They’re obliged to give you that help, since you gave them your money. But in reality, the automated help line makes you pay for the help the company already owes you. You don’t pay for the help in cash, of course. You pay for it in time, and you pay for it in stress. And all of this happens just so the corporation can save a few bucks. In this exchange, the corporation is not creating value; it is making profit.
This is what the ACA did for health care in this country. We are forced to undergo these awkward, unnecessary aggravations, because the Democratic Party didn’t have the backbone to stand up to lobbyists. Raising their voice would have been too much.
ACA gave people health care by punishing them. It followed the old neoliberal playbook: the poor can come in through the back door, but only if their crawling is good enough.
Health care is a moral obligation. Nobody should go broke because they get sick.
Health care is a financial obligation. The more people who pay in, the cheaper and more effective the insurance pool gets. It makes sense to make it as big as possible. When the layers of red tape, of lawsuits and HMO offices are cut away, health care is cheaper.
Health care is an obligation of justice. People have the right to not be taken advantage of by shysters and greedy companies.
With these obligations, any health care program is better than nothing, in the same way that a paper airplane on fire is preferable to zero aircraft.
In this sense, Obamacare is “successful.” But it’s successful in a way that’s easy to hate, because it’s designed by people who didn’t try very hard to change the world, just meet the minimal obligations I listed above.
Obamacare gave the people what they so desperately needed, what they ought to have. But it gave it to them in the most denigrating way. You can’t algorithm and means-test this stuff. Health care is not something you can hack. There’s no algorithm to be applied here. This isn’t an admission to Yale, God forbid. Americans ought to be protected by health care the way they’re protected by the Air Force. Everyone is a citizen, everyone gets sick, everyone needs money. Why is this hard to grasp?
Programs work when they are universal, because that is what people understand. Obamacare is better than nothing, yet nothing is what we will soon have.
Any time the pundits tell you the right wing can be worked with, remember this. Remember that their very first move when they got the power was pushing millions of people into the cold. Remember, remember.
What scares the GOP? The idea of their elderly base living long enough to find out they’ve been hustled. By repealing Obamacare, they’ve taken the first step in solving the problem of being found out. A mediocre fix is going out; the big fix is in.