Friday, July 21, 2017

Repealing and NOT Replacing Obamacare: NOT the Middle of the Road

In 2009, GOP legislators made a public commitment to ensuring the failure of the Obama administration. They opposed any actions by their democrat peers supported by the Obama administration, forcing Democrat congresspersons to push ACA through as partisan legislation. The result was a less than stellar solution to the nation's problems, and, predictably, after sabotaging "Obamacare" at every turn, the GOP made its repeal a central part of their (primarily anti-Obama) platform. When ACA met with some success despite their antagonism, 'repeal' became 'replace'; GOP senators and representatives claimed they had a superior alternative. That turned out to be a lie that left the GOP scrambling to draft a replacement after their promise helped them win the 2016 elections. In the face of widespread skepticism and dwindling faith, the Trump administration essentially promised that its ACA replacement plan would lower insurance costs so greatly that it would effectively provide universal healthcare.
Obviously, that was also a lie, and the actual proposed replacements have not gone over well with the American public, as the goal of those replacements has been primarily to alleviate the financial burden on the wealthier segments of our population, by giving major tax breaks to corporations and high income families. It's an approach that either reflects incredible greed, or zealous faith in the religion of Reaganomics, wherein the wealthiest Americans are prophesied to at some point, come down from their mountain and use their tax savings to offer salvation to our nation's poor and downtrodden, out of pure altruism and patriotism.
The Republicans' plans have been so bad that they've not only been opposed by those needing insurance, but by their doctors, hospitals, and insurance providers, all of which have vested interests in keeping Americans insured.
Now, with their proposed replacements failing, GOP legislators have returned to the 'repeal only' approach. After months of dodging any commitment on the repeal and replacement of the Affordable Care Act, one of my senators (Bob Corker) finally stated his official position on the matter - rather than leave ACA the way it is, or attempt to improve ACA, he's electing to follow the new (actually old) approach: repeal it and... do nothing.
Yeah, he wants to just pull it off and let the cancer patients hit the proverbial fan. He wants to see how it turns out, then return to the discussion when people have forgotten about ACA. No, for real, that's his reasoning. Corker's Facebook page (July 21, 2017):
After being involved in many discussions over the past several months with my colleagues and stakeholders across Tennessee, I believe the best path forward is for Congress to repeal the Affordable Care Act after a reasonable transition period. This takes us back to a level playing field where, by a date certain, all sides have incentive to work together to develop a health care replacement that can generate broad support and will stand the test of time. Regardless of how we move forward, it is my hope that our focus will be not only on coverage but also on lowering the actual cost of health care. 
{The statement is also, for the time being, available on his own webpage.}
"A level playing field." Corker knows that his GOP colleagues are unwilling to come up with a plan that's not obviously worse than ACA, so the only way to push forward an ACA alternative is to knock us backward, so that anything will sound like an improvement.
And that latter point is probably true. The Congressional Budget Office has already evaluated the ramifications of a straight repeal of ACA:
In CBO and JCT’s estimation, under this legislation, about half of the nation’s population would live in areas having no insurer participating in the nongroup market in 2020 because of downward pressure on enrollment and upward pressure on premiums. That share would continue to increase, extending to about three-quarters of the population by 2026.
The repeal would immediately yank insurance out from under 17 million Americans, and an additional 10 million Americans would lose their insurance by 2020. In all, about 10% of our population (32 million Americans) would lose their insurance over the next ten years as a result of the repeal. Their options will be (1) do without insurance, (2) find a job that provides healthcare benefits (because, you know, those are just there for the taking #sarcasm), or (3) buy insurance directly from the insurer on a non-group (i.e., individual) plan.
For those Americans who have or can afford to obtain a non-group plan, premiums would increase 25% more than they are projected to increase currently, 50% more by 2020, and 100% by 2026. If your insurance isn't obtained through a group market, the increase in your premiums over the next ten years will be doubled.
Why do something that's obviously harmful to the American public? For the same reason a competitive figure skater would have her opponent's kneecaps broken rather than actually try to be better; it's the easiest way to 'level the playing field'.{Yeah, I know, that reference is both dated, and yet 'too soon'.}
I imagine some people will claim that Corker has taken the 'middle' road between two paths, playing the moderate between the Democrat's ACA and the Republican's various attempts to replace it. This isn't a moderate solution, though; this is a 'scorched earth', 'cut the baby in half' solution. At this point he sounds less like he's representing his constituents and more like he's trying to punish them for not blindly supporting his party.
Anyway, the whole thing reminded me again of a metaphor that I've been using throughout this disagreement, and I thought it was worth posting at length:

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{Doctor #1 frantically evaluates the condition of an injured man. Doctor #2 comes in and asks what's happening.}

Doctor #1: This man's left femoral artery has been knicked! We need to do something or he could bleed to death!

Doctor #2: Yes, dying would be bad. We definitely shouldn't kill him.

Doctor #1: Yes... that's true... I've put a tourniquet just above the injury on his left leg to slow the bleeding.

Doctor #2: But he's still bleeding.

Doctor #1: Yes, he is, that's why I need your help to...

Doctor #2: He'll still die.

Doctor #1: Not if we finish the...

Doctor #2: And because of the tourniquet, even if he doesn't die, he could lose his leg!

Doctor #1: Yes, which is why we need to...

Doctor #2: What sort of medical professional are you?! Your patient comes to you bleeding to death, and your response is to cut off his left leg?!

Doctor #1: Fine. He's your patient now. You're in charge. Fix it.

Doctor #2: Right. Well, first I have to save his left leg. Move the tourniquet to the right leg.

Doctor #1: I'm not doing that. [Provides lengthy explanation of why.]

Doctor #2: But he'll lose his left leg if we don't move the tourniquet.

Doctor #1: But he'll lose his *right* leg if you move the tourniquet to the other leg.

Doctor #2: RIGHT, yes. He needs BOTH legs, doesn't he? Okay, well, the injury is preventing blood from getting to the left leg anyway, so I'll just move the tourniquet to BELOW the injury. Then it won't be blocking the flow of blood to the leg anymore.

Doctor #1: THAT DOESN'T ACCOMPLISH ANYTHING.

Doctor #2: Look, if you're going to be like that, clearly the only way forward is to remove the tourniquet altogether. That'll put us back on a level playing field, a clean slate, just like things were before you came in and meddled with my patient. Maybe after the patient's lost some more blood you'll be ready to work together and focus on saving this patient, while keeping the cost aff -

Patient: *BEEEEEEEEEEEEEEEEEEEEEEEEEEPPPPPPPPPP....*

Doctor #2: This is your fault.


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James N. McDonald is a "liberal academic" born and raised in Missouri and residing in Tennessee. He holds one degree in history, two degrees in psychology, but loves writing fiction. His first, completed novel, The Rise of Azraea, Book I, is a high fantasy story with elements of comic fantasy and satire targeting present day, real world issues such as economic inequity, and sexual and racial discrimination. It is currently available on Amazon.

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