Dead On Arrival
The Affordable Care Act will pass silently into the night unless you do something about it right now.
Full disclosure: since February, I’ve had a beer riding on whether or not the US Congress repeals the 2009 Affordable Care Act and replaces it with the legislative equivalent of blast furnace slag. And for the record, I bet on the blast furnace slag.
For all the speculation that the Republicans would not risk the backlash of stripping healthcare away from millions of Americans, I still expect to get the first round free when I drink to forget the naive fancy that major legislation can ever be used to better the lives of the American people. (
’s early pessimism in these pages proved prescient.)Many US-based politicos (and I, at first) relied on a layman’s version of Paul Piersons “The New Politics of the Welfare State”: welfare programs create new constituencies (i.e. folks who get their healthcare through the ACA) who in turn mobilize to keep programs from being downsized or axed.
What is surprising is just how quiet things seem on the liberal side of the playing field. Is there really no organizing capacity or energy left to send a strong message to various Senators that passing the AHCA — or letting it pass without a tooth-and-nail fight — risks their individual political futures?
Yet much analysis along the way has missed the fact that the GOP not only has the power to end the ACA but to make its end appear inevitable by whipping up such uncertainty over its future that the insurance exchanges fall apart of their own accord. Republican politicians and surrogates emphasize over and over again that Obamacare is doomed to fall apart, while doing everything in their power to ensure that this happens.
Debating about whether the ACA is doomed to fail at this is, to borrow from Hannah Arendt, akin to “arguing with a potential murderer about whether his future victim is dead or alive [. . .] The only valid argument is to rescue the person whose death is predicted.”
Nobody from the Grand Old Party wants public discussion on this bill — precisely to keep from stirring up an effort to rescue their would-be victim.
There’s a tendency on the right to sum up the original passing of the ACA as a massive Democratic effort to pull the wool over the eyes of the American people, relying heavily a single Nancy Pelosi quote that “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.”
Never mind that Pelosi meant the bill’s effects would unfold over time, there were months and months of intense debate and discussion over what would go into the bill, including a primetime speech by then-President Obama.
Even trying to account for some sense of today’s politics as usual, it has been equal parts fascinating and horrifying to watch the Senate hide its version of the bill in plain sight — legislation that will tear into one-sixth of the US economy and create 23 million more uninsured by 2026.
No matter how cynical we get about politics, it’s still worth bearing in mind Paul Ryan’s 2009 advice to reporters: “I don’t think we should pass bills that we haven’t read, that we don’t know what they cost.”
The Senate version of the American Health Care Act is being formulated in secret, to be sprung upon the American people as a fait accompli some days or weeks hence. The playbook will be the same as when the bill passed the House last month — announce late, move quickly, and whip up GOP votes by threatening to pillory dissenters as rejecting the will of the American voters.
Never mind that not a single state seems to support the AHCA by a majority.
Of course, Republican intransigence and secrecy while in near-absolute control of the US government is not exactly surprising. Nor is their utter failure to have a pragmatic, sellable alternative ready to go after six years of pledging to repeal Obamacare or to even answer a straight question about how on earth the coming bill will make the United States a better place for anyone other than the well-to-do who no longer have to worry about taxes to support the health of the less-well-off.
What is surprising is just how quiet things seem on the liberal side of the playing field. Is there really no organizing capacity or energy left to send a strong message to various Senators that passing the AHCA — or letting it pass without a tooth-and-nail fight — risks their individual political futures?
Indivisible has a 50-state plan, a 10-state plan (for the ten key Senators who could kill the bill), an impact summary, and a sample calling script for taking on the current health care plan. These are tremendous resources, and the work put into preparing them is flatly impressive. But I wonder if it will be enough; summer has begun, sending people outdoors and kids home from school(college students in particular). There are plenty of more important controversies to attend to, like what President Trump tweeted recently or what fawning praise his coterie of sycophants deigned to bestow upon him.
Before I spin off into pessimism, please, please, please do get some friends together and call your Senators. Either to try and force a public debate by slowing down Senate business (for the Democrats) or by imploring that your Senator work to bring the whole thing into the light (Republicans). We need three GOP senators to help kill this thing.
Let’s not forget, of course — one of major problems with how the ACA has been presented by its supporters has been a tendency to laud it as a major success without acknowledging how very incomplete and flawed a bill it was.
Or a tendency to sidestep those flaws by trying not to bring up the bill that much at all — perhaps a reason why so many Americans were apparently unaware that the ACA expanded coverage.
Yet the AHCA will not so much fix the flaws of Obamacare as douse the entire thing in gasoline and toss in a lighted match. Unless the good vibes of watching the thing go up in flames will be enough to keep you in good health and good spirits for years to come, even the skeptics among you really should be calling your Senators’ offices to ask exactly how the bill being cooked up in secret will magically lower premiums, increase freedom, expand coverage, reduce taxes, and help shrink the federal deficit all in one fell swoop.
Perhaps the GOP will champion crowdfunding as the free-market answer to Obamacare. This is not just Upworthy clickbait — medical expenses account for nearly 50 percent of GoFundMe activity, according to one study. “The campaigns with hashtags, images, and flashy elements got the most financial support,” another study found.
Welcome to a society where those unable to secure a diminishing percentage of full-benefits jobs must hope and pray that no major catastrophe befalls them, lest their very health and life or those of loved ones depend on their ability to rack up likes on Facebook or forwards on e-mail chains.
Likewise, while not a healthcare issue per se, opioid epidemics and drug abuse continue to eat away at rural communities. No matter how many copies of Hillbilly Elegy get read by well-heeled coast-landers, the problem is generally met with an attitude of “leave ’em lie, let ’em die.” What can we expect from a political leadership that has no answers on public health issues other than platitudes about market mechanisms and personal responsibility?
For those in search of some (cherry-picked and hideously under-analyzed) statistics, here’s what “small government” solutions look like up here in New England, where all states face a similar scourge in the form of opioid addiction and overdoses. New Hampshire has the lowest percent-of-GDP government spending in the region and the third highest death rate from drug usage in the country — despite an economy growing as much or more than neighboring states.
Ending the ACA does not mean that US healthcare enters a free-market utopia, where savvy consumers somehow gang up on multi-billion-dollar HMOs and pharmaceutical companies with affordable healthcare plans for all. As
has eloquently written here, even drug pricing is rife with power and information asymmetries that leave individual consumers at an extreme disadvantage, while undercuts the entire plausibility of free-market health care for Pacific Standard.So take some time over the next few weeks to call up your Senators. Ask for their health care policy advisor — by name if possible. Ask them what the bill hopes to achieve and how. Demand that the whole thing be brought up for public scrutiny.
And if all else fails, and this GOP slag heap passes, come find me at the Cantab or the Newtown Grill. Second round’s on me.
Andrew Leber is based in Boston.
