Wednesday, March 1, 2017

Response to Simple and Wrong

(See: Just Above Sunset: Simple and Wrong)

I remember hearing that, during commercial breaks of “I Love Lucy” back in the early 1950s, New York’s water pressure dropped measurably with so many toilets being flushed at the same time, so the other day, when I guffawed on hearing Donald Trump say, "Nobody knew health care could be so complicated!”, I wondered: If enough Democrats and Independents all laughed at the same time, might that cause a measurable earthquake?

If a new president really doesn’t know something because he hasn’t been keeping up with the news, I guess it’s okay to learn on the job, but I have a feeling that even if Trump had been paying attention over all these years to the Obamacare issue, he would still have been confused today, and that’s partly because the “Repeal-and-Replace” Republicans, despite their famous wont to keep things much simpler than they really need to be, have not had the guts to reduce the problem of healthcare in America down to its true essentials.

We need to go back and ask ourselves, what was the problem that needed solving?

The answer depends on who you were to ask. Democrats wanted everybody to have affordable healthcare, even if that meant “Medicare-for-All”, while Republicans mostly just wanted healthcare to be cheaper, especially for themselves and their family and friends, and didn’t talk at all about the idea of “universal” care. In fact, they ignored it altogether, as if nobody really believed in it anyway.

The Democrats drove healthcare reform in America back then, in much the same way that Republicans, especially under Trump, have been pushing immigration being a top-level political problem today, and what Democrats saw was too many poor and middle class people without jobs or health insurance (and also their children) showing up at hospital emergency rooms when they got sick or injured, and sometimes getting turned away once it was learned they were going to be unable to pay their bills.

At least that was true until politicians grew guilty consciences, passing laws that prohibited hospitals from turning away those who couldn’t pay, at which point the costs of their treatment, such as it was, would be passed on to the patients who could, but that sent hospital bills and insurance premiums soaring. In other words, by default, those of us who had the money to pay our bills, were also paying the bills of those who couldn’t.

Since the public was picking up the tab for the poor anyway, what was needed was a way for us to do it more efficiently, and with better outcomes, and probably at lower cost. The result, by an eyelash, was the ACA. Once it got going, most economists seemed to admit that it worked, with a few glitches here and there, but solvable ones.

Or else, depending on if the Republicans ever got in power, we could always go back to the way we were doing it before.

In fact, in a perfect conservative Republican world — although this would be one in which people feel no obligation to help anyone but themselves and their families; but that should go without saying — the hospitals would be told they are no longer under obligation to give away free healthcare, and should feel free to turn away anybody who can’t pay.

And those who couldn’t pay (and that includes their offspring) would go untreated, and would stay sick, and eventually die. That would be “unfortunate" and “sad”, of course, but with all these burdensome sick hangers-on out of the picture, they would cease to be our problem, and this, one would think, would cause insurance premiums and hospital bills to drop.

(Or would it? Or would the expenses of all that costly equipment, not to mention the salaries of medical personnel, just be spread across a smaller population of patients, which would mean higher medical costs for each patient, rather than lower? Whatever.)

Economist Paul Krugman asks the question, "So why do Republicans hate Obamacare so much?”, and has his own theory:
It’s not because they have better ideas; as we’ve seen over the past few weeks, they’re coming up empty-handed on the “replace” part of “repeal and replace.” It’s not, I’m sorry to say, because they are deeply committed to Americans’ right to buy the insurance policy of their choice. 
No, mainly they hate Obamacare for two reasons: It demonstrates that the government can make people’s lives better, and it’s paid for in large part with taxes on the wealthy.
My own theory is, conservatives are, on principle, opposed to the idea of government making it easy for people to live, thinking that “giving people stuff” instead of making them work for it only makes them soft.

How this principle — that of having to work for what you get — applies to their own kids, who generally get their health insurance from their rich parents, is a puzzle that rarely comes up in the discussion; nor does the question of why they believe in that principle, since it’s too hard for them to explain to people who don’t already share your prejudices.

Regardless, it comes down to one of two choices — (1) some sort of universal healthcare, with its efficiencies and better outcomes for all, or (2) what we did before Obamacare, with some people slowly dying in cardboard boxes because they haven’t the money it takes to stay alive.

So in a way, all those Republicans who’ve always thought that the healthcare question is not a complex one, have been right all along! It's essentially a simple choice between Healthcare-for-Everybody, and Healthcare-for-The-Well-to-Do, along with some sort of slow and painful death for most everybody else.

It’s really pretty much as simple as that! So what’s this big problem everybody’s been wrestling with all this time?

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