When you consider the position of the GOP regarding the ACA, or what they prefer to call Obamacare, there are only really three possible options, and each of them says something significant about the party. Mix in the fact that they haven’t been able to come up with any alternative beyond some vague noise devoid of specifics, and we’re left to consider just these three.
That they wish to repeal the ACA is not in doubt. They’ve tried so many times the mind boggles that they keep trying. They have to know that the current President won’t sign such a bill, and worse, they have to know that the next president, should it be a Democrat, won’t either. So…what is the motivation behind their intransigence? None of the answers are very nice, but that doesn’t change the facts.
Option one:
They simply don’t want the American people to have access to health care. The ACA has allowed millions of previously uninsured Americans to have health insurance at some level, and the number of uninsured has dropped precipitously. People who previously could not afford care now can. People who could not qualify for care now can. People who previously only went to the emergency room (the most expensive care imaginable) now have less expensive preventive options. It is impossible to argue that those aren’t good things…unless you simply don’t like people.
The ACA removed the pre-existing condition clause, which means insurers can no longer disqualify someone simply because they have a chronic disease or condition. Many more people now have the chance to live productive lives because they can get affordable help managing situations that are almost never their fault. Diseases such as diabetes can be successfully managed, meaning more productive people are available in the workforce, allowing them to live without the need for government assistance.
It is impossible to see these things as detrimental. Yet, when the GOP seeks simple repeal that is exactly what they are saying. There is no other way to interpret their actions.
Option two:
They dislike the ACA because it includes limitations on “administrative costs” allowed for insurance companies. This is a classic Follow the Money reality. In the pre-ACA days insurance companies could skim whatever they wished from the premium paid by subscribers. In reality that meant that they could inflate the salaries of those at the top, through wonderful bonuses and other means, and there was no penalty. They could do that without regard to coverage, partly because they had only the “market” to provide any level of “regulation.”
We know from experience in all sorts of industries, especially banking and Wall Street, that markets do not self-regulate. Competition does not breed efficiency, and when selling a product that all people will eventually need, there is no reason, beyond ethical behavior, to limit profits or salaries.
That same lack of regulation and competition meant that medical costs soared, far outpacing inflation as a whole. And why not? Heck, a doctor could prescribe all sorts of tests if the company would pay for them, and the company could simply raise rates to cover things. Doctors practice defensive medicine because the companies could simply pass along the costs. Doctors got kick-backs for prescribing particular drugs. The drug companies turned to advertising to the public so they could create a new avenue for demand…allowing the patient to self-diagnose and then demand a prescription for the drug they’ve seen on television.
We know that the GOP is against government regulation in virtually all forms, even to the point of voting to gut the Clean Water Act just as Flint is providing a text-book example of GOP management failures.
Option three:
This is the most simplistic option, and honestly, the most likely. It’s short, sweet, and to the point.
The ACA was created and promoted by That Black Man in the White House, and hence no matter what good it might do for anyone, including a lot of GOP members, it MUST be repealed. That man cannot possibly be allowed to succeed in any endeavor. If he says Tuesday should follow Monday they are obligated to disagree. It’s pathological.
The truth is that this motivation plays into both option one and two, combining to create a need that cannot be ignored.
Now there are some other things in play too, but they are largely tangential to the real discussion.
The GOP is in business…and make no mistake…it IS a business, of helping the rich get richer at the expense of the people who don’t matter. When it comes to health care, the best way to do that is to climb right into the doctor’s office and dictate medical care.
They rail against abortion, but want to defund or destroy the programs that make abortion less likely. The hopped on the bandwagon about Planned Parenthood, but couldn’t even be bothered when that phony attack turned out to be a barrel of lies. They preach abstinence as the solution, and watch silently while one of their abstinence spokeswomen has her second child, by a second father, out of wedlock. No big deal!
The collection of old white guys calls a hearing on birth control, and invites only old white guys to testify, and their radio spokesman openly slut-shames a woman for even wanting to testify. Pregnancy and birth may be a family planning issue…which they also decry…but it is far more a medical care issue. They’re willing to force the mother, regardless of how the pregnancy occurred, to carry the child to term, even to the point of criminalizing miscarriages, but rail against programs that might provide basic needs…like food…to that child once it is born. They also fight against the right of loving couples in committed relationships to have the right to adopt, simply because the couple isn’t “normal.”
Why haven’t they proposed some sort of replacement? They keep talking about doing so, but thus far? Nothing!
The reasons are simple. Absent going to Single Payer…which we know they aren’t going to do, there are no options. If you remove the mandate, the risk pool becomes only those who need care, and the effects of spreading costs are destroyed. If you remove the Pre-Existing Condition clause, people who need help will be cut off. If you remove the Medicare Expansion the poor people won’t be able to get care, and we’ll be back at the emergency room again.
It’s simply impossible to “fix” the system without including those things, and if you do include those things you end up with…yup…the ACA.
So…it’s a zero sum game. No matter how you look at it, there is no solution that will accomplish the same thing without doing the same things. And that gets back to the real underlying problem facing the GOP. They don’t have a replacement plan because there is none, and simple repeal means admitting that they just plain don’t give a damn about the people they supposedly represent. Of course, that’s not news these days, is it?