Blast #243

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                                                    Wherefore Health Care?
 
                   It looks like Mitch (the Turtle) McConnell has learned what our President told us several months ago: “Nobody knew health care could be so complicated.”  As the Republican Senate failed to bring their monstrosity of a bill to a vote this week, McConnell promised to keep working on it and I’m sure he will deliver a “revised” version of the legislation sooner than later.  However, the Republicans have had over seven years to craft a “repeal and replace” bill and what we have seen, in the House and Senate, are proposals that have met with wide scale disapproval from voters and states’ Governors (including Republicans).  How can that be?  Seven years!  As a matter of curiosity, I went back to see what the Republicans proposed back in 2010, as their alternative to the Democrats “Obamacare” legislation.  What is striking, I think, is that much of what McConnell (and the House bill that “passed” by two votes) is basically what was proposed seven years ago.  So, the Republicans have stuck to their guns, as it were (no NRA pun intended), while Americans have become accustomed to having health care under the Affordable Care Act.

             How can that be?  How can all those people who voted these Republicans into office suddenly support Obamacare?  A Morning Consult poll (a nonpartisan digital media and survey research company established in 2013 in Washington, D.C.) conducted in late January of this year found that 35% of people did not know that Obamacare and the ACA were the same ---and that percentage was higher with 18 to 29 year olds and people who made less than $50,000 a year.  So, as has been chronicled in this blog numerous times, about one third of public are shockingly ignorant and operate in a fact free environment where Facebook, InfoWars, and other very questionable sources are the basis for forming opinions on the significant issues of the day.  It is probably no coincidence that the President’s approval rating is 39%, slightly more than one-third of those polled.  (As interesting, of course, is that only 21% of Americans approve of the job the Congress {House & Senate} are doing --- neither Republicans, Democrats, nor Independents like what’s going on there).

                  Getting back to 2010, though, what were the Republicans proposing then and how does it compare with what they have presented in 2017?  Some of the proposals are easy to predict, given the basic philosophical bent of the Party (less “big government,” pro tax-cuts, more “individual choice”).  So we should not be surprised, when looking at the 2010 Republican alternative to Obamacare, to see that there was no public option (no government run “insurance exchanges”), no new taxes (vs. Obamacare’s “subsidies” based on taxing wealthier Americans), and no allowance for “pre-existing conditions.”  The Republican proposal featured the creation of small business “pools” and “high-risk pools,” as well as incentive payments to states that were then supposed to manage the reduction of premiums and the number of those uninsured --- making it a state responsibility rather than the Federal government's (long a Republican rallying cry).  The original  (2010) proposal did not cut Medicaid for Seniors (there was, of course, no expansion of Medicaid, as Obamacare created) and it featured a strong plank for medical malpractice reforms.  Their emphasis was for “consumer choice” vs. the “safety net,” believing the Federal government should reduce (or eliminate) entitlements while the Democrats passed legislation that prescribed mandates, penalties (for not buying insurance), and subsidies (to help pay for insurance).  Irreconcilable differences.

                A huge sticking point in the current debate is Medicaid --- and it should be.  Medicaid spending is a huge burden on the Federal (and each individual State) budget, particularly going forward (into the 2020s) --- and the Republicans and Democrats can’t find common ground to negotiate the problem.  While I don’t have any solution to propose (it will require much more research and homework to come up with that) I do have a pretty big question and it involves our expenditure for “defense.”  Based on information from the Peter G. Peterson Foundation (Nixon’s Secretary of Commerce and co-founder of the Blackstone Group, a giant in financial services), the United States will spend $611 Billion on Defense this year.  China, Russia, Saudi Arabia, India, France, the United Kingdom, Japan, and France will all spend $595 Billion combined this year.  Six of those 8 nations (who rank 2,3,4,5,6,7,8,9 behind the US in Defense spending) are our allies.  The question, to me, is obvious:  could we possibly spend less on Defense and allocate that money for Health Care?  What if we simply took the $16 Billion difference (between our spending & the next 8 nations) and applied that to Medicaid?  Why isn’t that possible?

            Whatever the case, this Health Care debate is far from over and I’d watch for Mitch McConnell returning from the July 4th recess with a newly revised version of the Better Care Reconciliation Act that can somehow scrape together the 50 votes he needs to pass it.  Then, of course, the House and Senate conference committee has to come up with some compromised bill and everything will hit the fan again.  What fun!