For my part the hearings have been edifying. Apart from appreciating the thoughtfulness with which Sonia Sotomayor framed questions, wearying of Stephen Breyer’s singsong college professor intonations, and noting again John Roberts’ courtesy, I finally understand that health insurance and care are two different things. In this economy, you get healthcare through health insurance. That’s why the broccoli analogy is all wet.
Vaporizing insurance companies as middle men was never seriously considered by Obama and his claque; that’s why I at least have blamed him for from the beginning. I also worry that AHCA may inadvertently — if I’m not being cynical — lead us in a few years to Paul Ryan-style atomization whereby, as Claire McCaskill noted two weeks ago:
“The irony of this situation is that these are private insurance companies people will shop to buy their insurance. It’s not the government,” she told KMOX of St. Louis on Wednesday. “It’s exactly what Paul Ryan wants to do for Medicare.”
“It’s subsidized by the government — premium subsidies — which is exactly, this is the irony,” continued McCaskill, who faces a tough reelection battle this fall. “You think what Paul Ryan wants to do for seniors, you think it’s terrific. But when we want to provide private health insurance for people who don’t have insurance with subsidies from the government, you think it’s terrible.”
Even Ezra Klein, who crunches on economic data like peanuts, can’t see the millimeters that separate the AHCA and Paul Ryan’s plan:
Republicans’ long-term interests are probably best served by Democratic success. If the Affordable Care Act is repealed by the next president or rejected by the Supreme Court, Democrats will probably retrench, pursuing a strategy to expand Medicare and Medicaid on the way toward a single-payer system. That approach has, for them, two advantages that will loom quite large after the experience of the Affordable Care Act: It can be passed with 51 votes in the Senate through the budget reconciliation process, and it’s indisputably constitutional.
Conversely, if the Affordable Care Act not only survives but also succeeds, then Republicans have a good chance of exporting its private-insurers-and-exchanges model to Medicare and Medicaid, which would entrench the private health-insurance system in America.
That’s not the strategy Republicans are pursuing. Instead, they’re stuck fighting a war against a plan that they helped to conceive and, on a philosophical level, still believe in. No one has been more confounded by this turn of events than Alice Rivlin, the former White House budget director who supports the Affordable Care Act and helped Ryan design an early version of his Medicare premium-support proposal.
“I could never understand why Ryan didn’t support the exchanges in the Affordable Care Act,” Rivlin says. “In fact, I think he does, and he just doesn’t want to say so.”
But, no, I have no interest in supporting the rescinding of court decisions that keep people with preexisting medical conditions and poor twentysomethings from the rolls.