Friday, March 10, 2017

Bad enough to fail

Victorian children. Via.
Dr. Krugman:

Given the rhetoric Republicans have used over the past seven years to attack health reform, you might have expected them to do away with the whole structure of the Affordable Care Act — deregulate, de-subsidize and let the magic of the free market do its thing. This would have been devastating for the 20 million Americans who gained coverage thanks to the act, but at least it would have been ideologically consistent.
But Republican leaders weren’t willing to bite that bullet. What they came up with instead was a dog’s breakfast that conservatives are, with some justice, calling Obamacare 2.0. But a better designation would be Obamacare 0.5, because it’s a half-baked plan that accepts the logic and broad outline of the Affordable Care Act while catastrophically weakening key provisions. If enacted, the bill would almost surely lead to a death spiral of soaring premiums and collapsing coverage. Which makes you wonder, what’s the point?
Hey, maybe that's the point! To furnish us with what they call a teachable moment—to demonstrate the truth of the sacred conservative axiom that government interference with the provision of health care is bound to lead to disaster.

Which has always been a problem because, as you know, it isn't true. It isn't true at all.

It isn't true in all of the world's developed countries other than the United States, where all the different methods of using government to guarantee universal access to medical care have been a virtually unmixed blessing. It's not true in the US either, as we know from the experience of Medicare, Medicaid, the Veterans Administration, and the great Federal Employees Health Benefits program that members of Congress and their staffs used to get to participate in until Senator Grassley made them all get Obamacare instead, which turned out to be not so bad either (anybody noticed how they've stopped telling us what terrible experiences they're having with it ever since they started having experiences with it?).

Because the Affordable Care Act has made it a bigger problem than ever, by remorselessly refusing to fail, in spite of all the predictions conservatives have made. And in spite of the efforts of conservatives to help it along on its way to inevitable death, whether through legislative sabotage, as in the attacks on the "risk corridors" through which government helps insurance companies insure themselves against market fluctuations (or what lyin' Marco Rubio calls a "bailout"), or direct judicial assault, as in all the lawsuits of former Oklahoma attorney general Scott Pruitt (EPA isn't the only thing he's tried to destroy) and his awful lawyer friends Jonathan Adler and Michael Cannon. It just keeps tooling along.

So maybe the Ryan effort here is to turn the ACA into something so bad it really can't survive, Obamacare 0.5 indeed, and then he'll be able to say, "See? I told you it was bound to fail!" It's to disrupt the situation—to "deconstruct" it as Stephen Bannon would say, to burn it to the ground and plow it under and salt the furrows so nothing can ever grow there again and generally make America safe for health care market anarchism, the way God wanted it to be.

Ryan took a lot of mockery yesterday for indicating that he never got it in Econ 101 when they were explaining how insurance works, as reported for instance at Think Progress:

The problem with Obamacare, Ryan claimed in this presentation, is that “the young healthy person is going to be made to buy health care and they’re going to pay for the person who gets breast cancer in her 40s or heart disease in their 50s.” He then pointed to a pie chart showing a thin red slice cut into a larger blue pie.
The red slice here [he went on to say] are what I would call people with preexisting conditions. People who have real health-care problems. The blue is the rest of the people in the individual market — that’s the market where people don’t get health insurance at their jobs where they buy it themselves. The whole idea of Obamacare is the people on the blue side pay for the people on the red side. The people who are healthy pay for the people who are sick.
Which is, as we've all been anxious to point out, exactly how insurance of every kind works, through what's known as the socialization of risk.

But, you know, I think we're being a little unfair to Ryan here. It isn't that he doesn't understand how insurance works. It's that he's against it. Or rather, against it for people who can't afford it.
Ryan defines what a person needs as what she wants to buy, if and only if she is able to buy it. If you haven't got the money for something you don't need it. You're not even worth discussing (his remarks are aimed at the person he cares about, who has the money but doesn't want to pay).

People of means can get together and pool their risks, as the shipowners did at Lloyd's coffee house three hundred years ago. Paying for the little people, the takers who earn their living by working instead of letting their capital work for them, is immoral, in Paul Ryan's view. Paying for it with tax money donated to the state by good people like Paul Ryan and his wife is criminal! It's not that he doesn't understand the economics of how it works, it's that he wants it to stop, right now.

And that's why government-assisted health insurance must end in flames, as the Prophecy says, and if it doesn't do that on its own, Republicans have to soak it with gasoline and provide the match.

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