Paul Ryan worked out his health care bill in a GOP-only clubhouse and rushed it through committees before the CBO had estimated the impact, but unfortunately for him legislation has to be published eventually, so now we can take a look at Trumpcare. It isn’t pretty.

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Here’s a good overview from Vox. Bottom line: Trumpcare will throw 14 million people off insurance immediately, and 24 million more in the next ten years, in order to give a $600 billion tax cut to billionaires who don’t need it.

The CBO estimates that a 64-year-old earning $26,500 a year, who currently pays $1700 a year for health care (i.e., after the Obamacare subsidy), would pay a whopping $14,600 under Trumpcare. Republican assholes think this person can just give up their iPhone, but of course the reality is that this person can’t afford that kind of “access to healthcare”.  They will go without insurance.  If they need the coverage, they will die.

And they probably voted for Trump.  Trumpcare is hardest on older people and rural areas, precisely the people who supported Trump and believed his lies about “terrific” health insurance that would cover “everybody”.

We’re used to Trump lying by now, but today’s point is that the GOP plan is the end result of years and years of Republican lies. The chief architect of this fiasco is Paul Ryan, a man who has a wholly undeserved reputation as an honest policy wonk, among pundits who desperately want to find such an animal in his party. In fact he’s a Randite whose only actual policy concern is to give the 1% more money and tear up the social safety net. It’s right there in his bill, but his public statements are full of polished lies about “choice” and “access” and the supposed evils of Obamacare.

Now, Republicans could, if they chose, be absolutely honest about their preferences. They could say they don’t believe in the government providing health care; that they are only governing to benefit billionaires; that they want to phase out Medicaid; that insurers should be able to deny coverage to whoever they want and make insurance unaffordable for the old and sick.  Probably two thirds of their voters would completely accept this— so long as they didn’t touch Medicare and Social Security. And as I’ve said before, repealing Obamacare is basically a return to the status quo of 2013.

But obviously this would be a political disaster with the muddy center of American politics, the 20% of the electorate which bounces left and right like a bobblehead and determines who actually wins elections.  Obamacare has insured millions of people who didn’t have coverage before; those folks like their new coverage, and are pissed that Republicans want to take it away. This is particularly important in the 20 Republican-led states which accepted Obamacare’s Medicaid expansions.

Klein and Schiff in the linked article make an excellent point about affordability. When health care wonks talk about health care affordability, they mean the nation spending less on health care. The liberal ones mean restraining the absurdly high prices of American health care (no other nation pays so much for so little). The conservatives mean reducing demand for health care. (Conservatives are convinced that everyone but themselves are hypochondriacs who only go to the doctor because their job or the government pays for it.)

When ordinary people talk about health care affordability, they mean what they themselves pay. People on expanded Medicaid are pretty happy: there are no deductibles and they can go to the doctor.  People on the marketplaces (like myself) are more likely to be unhappy, because deductibles have gone way up, and restrictions on who you can see have become way more cumbersome. But it’s still better than the pre-Obamacare options.

The thing is, Republicans have unwisely echoed those complaints— which means they are expected to do something about them.  You can’t say “the problem with Obamacare is high deductibles” and then create a Trumpcare that costs people 7 times as much.  That’s the problem with lying; it eventually catches up with you.

As Matt Yglesias has said, why don’t they just leave health care alone and just pass a tax cut? Mostly because Ryan and his co-conspirators thought that healthcare was low-hanging fruit. After all, they’d “repealed” Obamacare more than 30 times! The base would love them! They didn’t expect their town halls to be filled with angry constituents and the popularity of Obamacare to go up. And it’s apparently very hard for legislators to give up on a tactic and go try something else.

Ryan also seemed to expect that Republicans would just fall in line. The biggest wildcard, Trump himself, was no problem; his promises on health care turned out to be garbage. But a bunch of more-moderate Republicans in the Senate are terrified of being blamed for the catastrophe of Trumpcare, and a bunch of ultra-conservatives in the House are furious because some poor people will still get government assistance. There’s no way to make both groups happy at the same time, and it’s hard to picture how to threaten both wings to make them back down.

(The bill has to pass the House first, so the obvious “solution” is to make Trumpcare worse now, to appease the loonies, and then let the Senate deal with it somehow.)

(Maybe another lie will save the bill: promise that the real Trumpcare will be done later, and fix all the problems. Thing is, Ryan’s bill is somewhat limited by his insistence on passing it as a reconciliation bill, with zero Democratic support, but also no Democratic filibuster, because that’s the magic of reconciliation bills. The later bill would have to have Democratic votes. But if they had, or wanted, Democratic votes, they’d be pursuing them right now. The later better bill is a myth.)

Health care is hard, but all these problems are essentially of the GOP’s own making. The real problems people have with Obamacare could be easily solved with a magic ingredient: money.  But this solution isn’t available to Ryan, because he’s lost the old Reagan-Bush magic of approving of government spending when Republicans do it.  He’s created a mess for himself and the country, just to get that tax cut.

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