Sunday, August 13, 2017

Omni-splains -- Why Couldn't They Repeal Obamacare?

The Omnivore has written on this--and should not have to write it again--but an Omnivore Twitter friend who frankly should know better has asserted that the reason the GOP could not repeal O-care is because it was an entitlement--and an entitlement, once given, cannot be retracted!

Is this right? Wrong? Stupid? What?

The Chain of "Logic"

In this guy's mind it STARTED like this.

  1. Obama creates Ocare to help poor (black?) people at the expense of the middle class.
  2. Ocare passes and immediately wrecks health care in America.
    • The good people (him) lose their doctors and their good plans.
    • The bad people (poor people) wind up with horrible, too-expensive insurance.
    • The whole industry goes into a death spiral.
  3. The GOP wins election!! OUR SALVATION!!
  4. The GOP performs an epic face-plant.
  5. Trump decides that maybe he'll suspend payments to try to make Ocare die faster.
In this view of the world, Obamacare is bad for everyone. But, of course, that doesn't explain #4--if everyone hates Ocare, why not just repeal it and go back to it like it was before?

Seems simple, right?

You Can't Repeal An Entitlement!

It should have been simple. If the above was true then complete repeal would work. Right? But it turns out that #2 isn't actually true. O-care certainly shook things up--and it did make some things worse--but it also made a lot of things better

In fact, it looks more like this!
  1. Ocare passes in order to improve coverage--both of the poor and people who have traditionally been unable to access the healthcare market.
  2. It passes and, hey, it does that. The medicaid expansion works for the poor. The O-care regulations allow people with pre-existing conditions or kids just out of college to get covered!
    • OMG! People like that!!
    • It's disruptive--Yes, and Obama knew it was coming too. He did lie. Doctors get unkept. Plans get changed. Now: there was always some churn--and this continues--and a lot of it was blamed on O-care--but let's not pretend that O-care didn't cause a lot more change than "doing nothing would have."
    • Some people--such as this guy, who REALLY wanted to keep his specific doctor--were badly hurt. They hates O-care like Gollum hates hobbitses. That's fair.
    • Despite the benefits being popular, people are caught up on the individual mandate and, well, "Obama"--and it remains unpopular.
  3. THE GOP runs on Ocare and WINS! SALVATION IS AT HAND!
  4. The GOP has pledged to provide healthcare--'just like it used to be'--but much cheaper! Even for pre-existing conditions. This is impossible, but people believed it. They epically faceplant trying to provide it.
  5. Trump, not really understanding what went wrong--and the GOP, in general--unwilling to explain to their constituents that what they were distinctly promised is, in fact, impossible, spin out of control. Trump decides that if he kills O-care maybe it will become unpopular enough that it could be repealed.
Now, our guy understands the logic here. If most people are actually liking what it does then it can't be that it just totally sucks for everyone. So . . .

It's Too Expensive--And Failing!!

He recalibrates. The problem isn't the O-care benefits--those are an entitlement people actually want. The problem is the huge tax-burden on the middle class--and, oh, that it's failing!!

In this chain of logic:
  1. Obama passes O-care delivering stuff people want with some stuff (the mandate, new taxes) people don't.
    • BUT--it is too expensive!! 
    • And it is DESTINED TO FAIL!!
  2. More people like what they're getting (or don't care much what has changed). It remains unpopular until people are given an actual list of alternatives.
  3. The GOP, pushed to the wall by their victory, suddenly have to deliver the LIST OF PARTICULARS.
  4. The GOP prays that someone--anyone--will take the blame for it not passing and throws their hands up.
    • They are okay with blowing the budget for a wall or something--but not for health care.
    • Also, what they really want to do is cut 880MM taxes on the 1% that O-care imposes.
    • A lot of projections show that O-care can, in fact, continue--especially if there is less uncertainty around the political future of the bill.
  5. Instead of trying to save it, Trump and the GOP realize "it cannot be saved" and, instead, try to kill it more quickly in order to try to make some other alternative look better.
At this point, what the guy's logic must mean is that the law is literally unsalvageable. That it could not be fixed in any meaningful way for any reasonable cost (and remember, this is a GOP that is willing to blow a trillion dollar hole in the budget for their other priorities).

Now, he knows that's not logically true. He's even been told (correctly) that other entitlements (Medicare, Medicaid) had similar problems during their roll-outs but they got fixed by congress.

So why is he clinging to this nonsense?

Because the alternative is horrible.

The Real Reason They Couldn't Repeal Obamacare

The reason the GOP couldn't repeal and replace O-care is because it's a conservative solution to start with. You will use healthcare at some time in your life. Making you pay in advance is legit. At least that's what Romney and the Heritage Foundation thought (and this guy considers Romney a great man--so, you know).

Now, O-care DID add some libby stuff in, like making sure they couldn't sell you junk insurance. Ayn Rand is rolling over in her grave, yo. But still--the problem is that the GOP doesn't have a solution that fits their needs because their isn't one.

What they were responding to is a base that desperately wanted to erase every possible legacy of Obama for, uhm, "partisan reasons" (and by "partisan reasons," The Omnivore points you to Mr. Trump refusing to denounce white supremacists at yesterday's Unite the Right march). But you won't hear that on Fox & Friends.

When forced to combine their base's unspeakable (literally--like, you can't say that) with the reality of the impact on their voting populace, they failed utterly.

And what's worse: they can't even explain it to people who don't know.


  1. Speaking as someone hip deep in the medical insurance industry, it remains baffling to me that the real reason for runaway premium costs: the lack of regulation on medical and pharmaceutical pricing, continues to be completely ignored. The lobbbyists explain why congress isn't talking about it, but I can only assume that the average Joe isn't talking about this because they are unaware of how ridiculously arbitrary and inflated their base medical costs are, and the providers have bought in to and gamed the system so badly that you'll never hear a doctor talk honestly about this.

  2. It's true. Our medical/pharmaceutical industry - and, make no mistake, that's exactly what it is - has degenerated into a cruel and arbitrary hostage racket. Fraud and other villainy is omnipresent at all levels, because no one - not the providers, not the administrative staff, and certainly not the patients - have even the faintest idea what anything really costs. This results from a near-total lack of transparency, and what economists like to term "informational asymmetries".

    As long as we have to endure incomprehensible hospital bills with $400 line-item charges for things like "Misc. Svcs" (is this Tylenol? Maybe.), the shenanigans will continue. Why say "black eye, right side" when you can use an ICD code like "S00.11XA"? Or a "REVE" CPT code instead of "red-blood-cell count"?

    Also interesting: which professions decided to use a dead language in which to perform at least some of their internal communication, and why?

    -- Ω