What's ailing health care
WASHINGTON — The Senate health care bill, which was scuttled Tuesday until after July 4, was doomed by two narratives: Republicans are mean, and poor people would be dropping like flies.
Assisting the opposition was none other than President Trump, who called the earlier version passed by the House "mean." Trump met with Senate Republicans Tuesday afternoon to plot their move to repeal and replace Obamacare, which remains the GOP's objective.
The "mean" meme was easy enough to embrace given the bill's cuts to Medicaid, which provides coverage for the poor, disabled and elderly. Nearly two-thirds of nursing home-residents are supported primarily by Medicaid.
Adding insult to injury, the Senate bill included tax cuts for the wealthy, while also promising higher insurance premiums (in the short term) for middle-income earners. Get this: A family of four earning $56,800 a year would have seen annual premiums jump to $20,500, almost the same amount of a proposed tax cut for someone earning $1 million a year.
The image of the yachtsman polishing his brass fittings while children and elderly women tread water below springs to the minds of cartoonists and incumbents. Thus, a rising number of Republican senators were threatening to vote "no" on their own party's bill, which would have killed it.
While it's true that those insurance rates for middle-income earners would go up for the first couple of years — by a lot — it's also true that they'd soon thereafter drop to 30 percent lower than current rates. This is according to the nonpartisan Congressional Budget Office, which on any given day is a brilliant economic oracle or the crazy bird lady with canaries in her hair.
The media have been mildly rabid ever since Republicans went into a secret cave somewhere to hammer out their ill-fated plan. They've slammed the GOP for proposing to dump 22 million people from insurance coverage, despite the fact that millions of those would likely be dropping themselves — self-deporting now that coverage would no longer be mandated, as it has been under Obamacare. Otherwise, popular punditry doesn't permit much discussion of details and tends to favor nibbly nuggets of nonsense. I was surprised to hear MSNBC's Joe Scarborough go death-squad on "Morning Joe" Tuesday, saying that "poor people are going to be locked out of their doctors' offices." Obviously, he was speaking metaphorically, but such hyperbolic fulminations can become memes of their own.
Also rarely if ever mentioned, states already fund about 40 percent of Medicaid — and no one was forcing them to cut their programs, as James Capretta of the American Enterprise Institute pointed out. Moreover, the federal government will still spend about $5.2 trillion on Medicaid during the next decade. The Senate bill, meanwhile, proposed spending money on reducing premiums so that insurance would attract younger, healthy people to stabilize the market.
Would this work? Clearly, it hasn't under Obamacare. Having the young and healthy sign up was crucial to the success of the Affordable Care Act. Since they would likely be infrequent consumers of health services, their premiums theoretically could defray the cost of treating pre-existing conditions, as well as insuring the previously uninsured.
Despite a government mandate and penalties for failing to sign up, young Americans basically responded with "You're joking, right?"
The mandate's failure to be persuasive should have surprised no one. Government-enforced altruism doesn't sit right in a nation conceived during a tax revolt and born in the cradle of individual freedom. And, if I may stroke realism's head for a moment, health insurance and pre-existing conditions are fundamentally incompatible. Sick Person A gets insurance coverage only if Healthy Person B helps pay for it. Half the country is fine with this proposition. The other half would rather skimp on medical care than surrender a drop of freedom.
This, in essence, is what makes bipartisan reform so difficult.
To the conservative mind, the repeal-and-replace bill wasn't so much mean as tough. To the liberal mind, it was indefensibly heartless and cruel. But if one thinks reducing the debt and deficit is necessary, then isn't entitlement reform essential?
When would such cuts ever be popular — or painless?
Somewhere between the thorny cliffs of Dire Straits, where millions die from Republican meanness, and the gently sweeping shores of Obamaland, where everyone gets a lei and lives to 150, is a big enough boat to get us to market-based health care reform.
For now, go wash your hands.