I’m reading a lot of articles on the Right about the GOP’s failure to either reform or replace Obamacare, despite the fact that it is inevitable that Obamacare will crash and burn in the next few years. (By “crash” I mean there will be regions of the country where it will be impossible for anyone to buy private health care insurance. Already we’re very close to that now.)
For example: Back to the drawing board on health insurance reform
(As a footnote, by Executive Order, President Obama delayed or halted the full implementation of the PPACA (Obamacare, or the “Patient Protection and Affordable Care Act”) in the group insurance market. Which means if you get your insurance through your employer, it is very likely you are not getting insurance which would be considered “adequate” to sell in the private exchanges. It is also likely you are getting heavily subsidized insurance through your employer, which means you have no idea how much private insurance on the exchange would cost.)
Look, the blunt reality is this:
Obamacare created a massive welfare program for subsidizing health care insurance, as well as adding a component which requires everyone in the United States to buy health care insurance as a matter of law. The scoring from the CBO which was latched onto by Democrats showing millions losing insurance suggested they would lose insurance not because insurance would get too expensive. It’s already too expensive. No; they’d lose their insurance because the law would no longer require them to buy health care insurance.
But even without the individual mandate, the cost for health care is massively subsidized for the poor through transfers from the rich–making it, by definition, a welfare program.
It’s why, if I were to buy health care insurance from the private exchange for my wife and I, it will cost us around $1200/month for insurance. But if you’re middle class, you get a “tax credit”–essentially middle-class welfare–to afford that policy: if my wife and I made around $60,000/year, which is the average income in the United States today and placing us solidly in the “middle class”, income-wise, we would qualify for an $825/month subsidy from the government.
Such a massive middle-class welfare program is not going to be eliminated easily.
Too many people are enjoying bread and circuses–taking those bread and circuses away at this time would crush a number of families. They’ll be hurt anyway, as Obamacare starts to fail in various states: already about 1/3rd of the country only have 1 choice for private care insurance, and in some of those states, that private care insurance provider is in serious economic trouble: because insurance companies cannot compete across state lines, it wouldn’t be hard to imagine one of them going bankrupt.
(And when those insurance companies fail we’re in uncharted waters: what happens with the PPACA when a private citizen is legally obligated to carry health care insurance–and legally not permitted to purchase health care insurance?)
But that day hasn’t happened yet. And too many people are counting on blaming President Trump for Obamacare’s failure if the GOP cannot do anything. From a political perspective it is the perfect strategy: blame the Republicans for failing to fix a health care system not a single Republican voted for a decade before, and blame them for the health care system failing in precisely the way they predicted.
Republicans have become the children of Cassandra: cursed with the power of prophecy, doomed not to be believed, and ultimately blamed when their predictions come to pass.
It’s a shame too many “little people” (like you and me) have to get crushed under the weight of a failing system that was (according to some) supposed to fail–crushed so as to force the government into a corner and make them to provide government-provided single payer health care.
After all, when (not “if”, but “when”) the PPACA private exchanges fail in various states, what else is there left but for the government to put together a hastily-contrived government-run single payer system? I’m sure there are people inside the D.C. beltway who have already drafted legislation to that effect.
So that’s why the GOP keeps failing.
Not because the GOP is stupid. Not because they are failing to provide leadership.
But because Obamacare is such a massive “bread and circuses” bill that you cannot roll it back. If suddenly the average family had to pay for health care insurance what my wife and I are forced to pay–it would be absolute fucking madness with chaos in the streets.
And because no-one believes conservative predictions of Obamacare’s impending failure.
You cannot repeal Obamacare.
You must instead fix it.
There is no other choice at this point. Tens of millions of people are receiving hundreds of billions in transfers thanks to Obamacare. No-one wants their subsidies taken away.
Instead, the only way you can eliminate those transfers is to eliminate the need for those transfers.
And there are only two possible paths:
(1) Implement a single payer system.
(Which, in my opinion, would be an unmitigated disaster for a variety of reasons.)
(2) Slowly and carefully dismantle some of the regulatory restrictions on the health care system and on the health care insurance system which has locked 1/5th of our economy into a death spiral because no-one has the freedom to innovate.
If done correctly, as innovation in how we provide health care help to lower the cost of health care, and as health care insurance choices allow people to use insurance as it was intended–as a wealth protection device unnecessary for the poor (who can seek out government assistance that should be better and more intelligently funded), the price of health care insurance can finally stop their century-long rise.
Sadly I don’t know which choice we will take.