(MANDOS POST – YOU KNOW THE DRILL)
The Republicans are working hard to pass an amendment to the ACA called the AHCA. Assuming it succeeds, which I wouldn’t take for granted, it would take Obamacare, with all the latter’s deficiencies and faults, and make it even worse. Meaning: It will probably kill a lot of people through health care denial due to pre-existing condition denials and the reinstatement of lifetime coverage limits. If they fail to pass it, it would be because Obamacare is designed to make itself hard to retract; as Obamacare contains the bare minimum required to improve the status quo ante, anything significant they take away from it renders it unworkable. If it passes, it would be because they had decided that it was the closest to the status quo ante that they could achieve.
The status quo ante was terrible, but contrary to the beliefs of many, it wasn’t “unsustainable” in some sort of fundamental way. It could be contained by gradually excluding more and more people from insurance coverage, and therefore, down the line, care. This is not a debate about health care, but about how to pay for health care. It is about austerity, and the status quo ante was ultimately just a slow ratcheting-up of austerity. (Yes, I know, Obamacare is a ratcheting-up of austerity, but it is a slower one.)
One of the talking points against the AHCA is that it appears to be designed to give the rich a tax cut. However, the tax cut is, in proportion to many of its beneficiaries, quite small, even as it dwarfs the incomes of many. It’s not a giveaway that in itself should raise the political passions of its beneficiaries. Many of them won’t spend it or won’t notice the effect on their lives or wealth planning. Even the insurance industry is skeptical of key portions of the bill, and they’re not prone, as they say, to altruism.
The Republicans have invested a lot of political capital in the idea of undoing Obamacare. Instead of that small a tax cut, if they were rational political actors, they could easily have come up with a bill that targeted large swathes of their constituencies for a substantial improvement in their (bad) standard of coverage, even if they wanted to target Democratic constituencies for tribal reasons. They could have done this without even instituting single payer (aka public monopsony) and ruining their constituents among the insurance and corporate medical sector. It doesn’t appear that this is on order.
The picture only makes full political sense if you see the cutting of health insurance coverage as a political goal in itself, if not some kind of fundamental ideological “end.” Or for the symbolic appearance of trading coverage for a token tax cut, in a way that is likely to create further damage to the US economy. And that successful Republican politicians think that they can expel millions of people from the ability to pay for health care, including their own constituents, is a sign both of the significance of that symbolic appearance and the cultural limits of the US health insurance debate.