Monday, March 13, 2017

Trumpcare vs. Obamacare: Apocalypse Foretold

The Congressional Budget Office report on Trumpcare is out, and it’s devastating: 14 million people losing insurance in the first year, 24 million over time, with premiums soaring for older, lower-income Americans — in many cases, the very people who went strongly for President Trump. The C.B.O. thinks it would reduce the deficit, but only marginally, around $30 billion a year in a $19 trillion economy.

Let me offer one assertion and ask two questions.

The assertion is that something like this was to be expected. The C.B.O. came in even worse on coverage than most predicted, but it was obvious that the news would be terrible because that’s what the logic of the situation told us.

Obamacare imposes a mandate to induce healthy people to sign up, offers means-tested subsidies to make insurance affordable and expands Medicaid to take care of people with really low incomes. Trumpcare eliminates the mandate, slashes subsidies overall and redirects them to those who don’t need them and sharply cuts Medicaid. Of course that leads to a huge drop in coverage.

Or to put it differently, Obamacare is actually an intelligently designed system, and Republican claims that they could do much better even while slashing funding so they could cut taxes on the rich were always obvious nonsense.

Trumpcare is a slapdash, incompetent piece of legislation; but even a much more competent set of people couldn’t have done better given the constraints of Republican Party ideology.

Now my questions: First, can this legislation still go through? I have learned never to underestimate the cravenness of Republican “moderates,” who may posture to the center but almost always cave to the hard right when it matters. But even so, it’s hard to imagine this act of cruelty getting 50 senators. And if it can’t pass the Senate, won’t right-wing purists in the House decide to advertise their purity by voting against a bill that still falls short of free-market ideals rather than vote for Obamacare 0.5?

Second, what were Republican leaders thinking? Something like this C.B.O. score was a foregone conclusion; would it really have mattered much if it were 15 million losing insurance, not 24 million? How was this supposed to work out politically?

Again, I wouldn’t count out the possibility that this law will be rammed through regardless, with budget analyses relegated to the category of fake news. Democrats might even want to hope that this happens, so that there is no question about who to blame if insurance collapses. But the lemming-like way Republicans rushed into this disaster is still amazing.

NYT

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