Wednesday, June 28, 2017

Response to No Eleven-Dimensional Chess Here

(See: Just Above Sunset: No Eleven-Dimensional Chess Here)

It’s hard to understand how we ever got to this place of battling healthcare plans.

Try to remember back to when the two parties first offered up their proposals. Do you remember roughly what each contained?

You may remember (as I do) that the need for some sort of plan was sparked mostly by recognition that not everybody in America had access to medical care, much less the quality of health care necessary to thrive. If you or your children weren’t healthy and didn’t have the money to see a doctor on a regular basis, or even to check into a hospital when needed, your only choice was to show up at an Emergency Room, waiting sometimes for hours in hopes of receiving some treatment that you could get for free.

Hospitals, of course, might try to charge you for ER services, but usually couldn’t collect, and unless your life was at risk, they wouldn’t keep you overnight, so you would be asked to take your illness home where, without medical treatment, you could easily die. Eventually, we passed laws against hospitals kicking you to the curb. Still, any costs from your visit would be absorbed by the facility and passed either onto patients who could pay, or to their insurance companies.

The Democrats, who saw this as a problem that needed to be solved, started working on a national program to take care of it, grounded in their belief that, if there’s something that society really needs and it’s something that the private sector either can’t handle well or at all, then we all need to look to the public sector to solve it, so during the election campaign of 2008, the Democrats struggled to come up with a plan to cover as many as possible.

Meanwhile, what was the Republican approach?


Republicans, by and large, didn’t see any of this as a problem, or at least not one that government should get itself involved with. Their idea was no idea at all — just let things be. Can’t afford health insurance? Get a job, and get coverage from your employer.

If, on the other hand, government runs some program that makes sure everyone can see a doctor even if they can’t afford it, that means the people with money will be paying for the medical care of people without, and maybe that’s the way it’s done in other countries, but it’s not done that way here. All that sort of thing does is encourage people to be lazy, it was argued, and what kind of country would we be if we allowed everyone to be lazy?

In short, the Democrats came up with a plan, and the Republicans refused to, and once the Democrats took over and passed their plan into law one year later, the Republicans started promising to repeal it. In fact, they made fifty-something attempts, but couldn’t get the Democratic president to sign them.

But as the years went by, voters started asking the Republicans what plan they would replace the Democratic plan with, and they were too embarrassed to admit that, since their real objection to the Democratic program was that it was a program at all, they had nothing to offer in its place.

But after a while, some Republican who lacked the ability to foresee what problems this would cause down the road, started claiming, “Of course we wouldn’t just repeal the law without replacing it with something better! Our idea would be to, first, repeal the old law, but then to replace it!”

And when people, once again, asked what they’d replace it with, they started saying, “Oh, don’t worry! We’re working on lots of good ideas! And our ideas are much better than that Democrat idea! Just you wait and see!”

And that brings us up to date, when Democrats howl at how many millions of poor people the CBO says will lose insurance under the most recent Republican bill, smiling Republicans come back with the incredible argument that, because of their newly-granted “freedom of choice”, they are not being thrown out of the healthcare system, those 22-millions would now just be choosing not to purchase it!

(And how is this new Republican-granted “freedom of choice” different from the freedom to not own health insurance that existed before Obamacare came along to “enslave" those millions of poor people, you may ask? Not at all, it turns out, and that should tell you something.)

It’s hard to predict whether they might have been better off just sticking with their original idea — of being the party without a plan, because they don’t believe in plans — but the damage is already done, and there’s no going back.

By now, they’ve got not only Republicans on the right who come close to being “originalists” — those who would prefer to just “repeal” the damn thing, and take their chances — but also some “moderates”, who don’t want anyone to be hurt by repeal — who somewhat naively bought into the idea that you can somehow have a healthcare system that has no requirement for everyone to own insurance, and still be able to pay for patients with pre-existing conditions!

All this new-found magical thinking on the part of Republicans seems to lead both sides to have faith that the two concentric circles of belief can still somewhere overlap, but I’m betting that this probably won’t happen, and furthermore, if it does, the overlap will be minimal.

And I’d go further in saying there’s also a certain amount of magical thinking behind this as well:
Trump associates are cautiously confident that McConnell will eventually secure the necessary votes when the Senate returns from its July 4 recess. He was central in shepherding Trump’s most notable victory – the confirmation of Supreme Court Justice Neil M. Gorsuch – and that experience in particular, they said, forged their trust.
The confirmation of Supreme Court Gorsuch is being hailed as “Trump’s most notable victory”?

Big Whoop! Such an accomplishment! Who did he triumph over, the Democrats? They had no power to stop it! Take my word for it, if we coulda, we woulda.

But how about now that the McConnell railroad seems to have derailed? Is this now our chance to offer the Democratic idea — that is, neither “repeal” nor “replace”, but “repair”?

It’s hard to imagine how that would work, in that for Obamacare to function, it has to stay in existence (something that would be a deal-killer for at least the conservatives, whose whole idea is to transition it into nothingness) and would have to retain the mandate (everyone needs to sign up, to make it pay for itself — an idea that no Republican of any stripe seems to like.) We Democrats would likely just become a third non-concentric circle that, like the other two, overlaps with nothing.

But how about the idea of all the Democratic senators joining with a few moderate Republicans, overpowering the rest of the Republican conference? Not sure how that even gets started, but even if we got a Senate bill sent to the House, it would probably die there — and if not, it’s hard to see it getting enough votes to ever override a Trump veto.

Maybe the only way out of this is to get ourselves re-elected, not just to the White House but to Congress, too.

But while we’re thinking big, we might as well take advantage of recently-improved public opinions about the whole national healthcare concept and start making the case for single-payer — or even better, an actual taxpayer-supported "National Healthcare System” — the real thing, just like the one they have in Britain!

Why not? It would be less complicated than our system, and much cheaper, and with better outcomes, and it would cover everyone, which is exactly what a government-run healthcare system should be.

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