Do Republicans Really Think The AHCA Is A Good Idea?

What exactly are they trying to achieve?

Are they trying to create the best possible health care system?

Do they think it will move us in that direction?

I get that it would be really hard to convince Democrats to work with them (given all the good will they’ve built on the subject over the last 8 years), but do they really think this is the best way to write legislation that will impact a full one fifth of the U.S. economy?

I know they think the Affordable Care Act sucks, but are they daring to go where its authors wouldn’t? Are they rolling up their sleeves to tackle the biggest drivers of health costs in this country to devise a more efficient system that makes some kind of non-historic accident sense? i.e. Are they boldly taking on big business and labor to rethink the tax provisions, that enable the Rube Goldberg way folks get health insurance in this country?

The Affordable Care Act is far from perfect. Hell, you might even say, passing it did about as much to fix our health care system’s biggest problems, as putting a bucket under a ceiling drip does to fix a leaky roof. But are the Republicans , who support this bill trying to redo the roof or are they just fixing to kick over the bucket? Because it sure seems like they’re just trying to do the latter.

Paul Ryan says the law must be repealed because, “this year alone, premiums have gone up by double digits in 31 states,” but weren’t insurance premiums increasing just as fast, if not faster, before , the Affordable Care Act became law? Seriously. During the six years before, Barack Obama became president, the average health insurance premium for a family with employer-sponsored coverage went up by 58% , while millions of families lost their health insurance, because their employers could no longer afford to offer benefits.

Did the speaker just forget there was a reason both presidential candidates were calling for health reform back in 2008? Does he really believe the Affordable Care Act is the main reason premiums have continued to rise since it became law (that they wouldn’t have continued to rise had the ACA not become law) or has his party just not been letting the truth get in the way of their taking a cheap shot on Democrats?

Ryan says the ACA is failing because “[the] choices [available in the ACA-created exchanges] have dwindled to the point that one out of every three counties in America has just one insurer to choose from ,” but isn’t that one more choice than a lot of those Americans had, back when insurers were allowed to deny them coverage for having a preexisting condition? And one less than the CBO says millions of them will have if the AHCA becomes law and allows insurers to go back to trying to be the best at only insuring healthy people?

Yes, I’m aware that the AHCA will create some sort of “high risk pool” to help ensure they can get coverage, but given that high risk pools have always proven to be really, really, costly can the folks, who support this approach, please tell me how it won’t just make our costly, inefficient health care system that much more costly and inefficient? I’m asking, because I can’t see how it makes sense.

Plus, aren’t insurers deciding to stop offering coverage in the exchanges because the folks, comprising those risk pools have proven to be riskier and more costly to cover than they’d hoped? If that’s the case what makes proponents of this approach think that “deliberately” high risk pools will be able to offer more, affordable health insurance choices? Or don’t they care if THESE Americans have affordable choices?

Are they at all troubled by the fact that they will be relegating their constituents to what amounts to “health insurance ghettos” if they’ve had the audacity to do something like get cancer or seek treatment for depression? They are aware that “preexisting condition” label applies to a pretty wide variety of things, right? (I mention this, because, I, honestly, spent 7+ years working on health policy in Congress and didn’t realize that it applied to me until I couldn’t get insurance on the individual market, because I take medication for ADD.)

So, are they really saying that I’m less worthy of health insurance, because I take $40 of pharmaceuticals a month to help me be a better writer, than, someone, who has gone undiagnosed or refused to get treatment? That getting help for depression or an eating disorder or insomnia, migraines, chronic back pain, high blood pressure etc. etc. etc. means a person should have to pay considerably more if they break their arm or get cancer? Although, I guess that makes about as much sense as thinking someone, who works for a big business deserves better health care than someone, who works for a small business, let alone someone, who has the audacity to start a business?

For the record, not using health services is NOT like not using your car insurance. Getting into a car accident not only tends to be avoidable, it doesn’t make you a better driver, whereas not only are many health conditions unavoidable, avoiding treatment actually tends to make them worse not better.

Seriously. Do the Republicans, backing this bill, really thinks any of this makes sense?

Do they really think eliminating the ACA’s insurance mandates will be good for consumers? I mean, do they not know that absent those mandates, insurance companies have a long history of marketing policies that seem great (because they have low deductibles and co-pays) but actually suck in the event that you need something more costly than an office visit? Do they not care that those mandates are a big part of the reason Obamacare has helped reduce personal bankruptcies by 50% ?

When they say their plan will foster a “real marketplace” for health care, do they realize that the rules of that market will encourage companies to compete to shed risk and trick consumers with fine print vs. provide the best health care coverage at the best cost? Yes, I know mandates are not the only way, to ensure consumers don’t get screwed, but given that Republicans haven’t told their constituents why ACA eliminated their previous health plan (and that they’re better off for it), why should I believe they’ll do a better job of telling consumers they truth if they manage to repeal the mandate?

Do they care that they are backing a shitty policy? Or are they backing a shitty policy, that could do real harm to millions of Americans, because they think it would be better to pass a shitty policy than to admit they’ve spent the last 8 years advocating for shitty policy?

Yeah, I get that they’re in a tough spot. They’re being asked to enact legislation based on eight years of attack lines that have no basis in sound health policy, let alone reality. That’s next to impossible. But isn’t it next to impossible for a reason? Will they, at any point, learn that what’s most politically expedient in the short term can really end up screwing you in the long term?

Finally, do you think it’s occurred to the authors of the ACHA that they’re the ones responsible for the problems they’re purportedly trying to solve?

Have they ever considered the fact that the Affordable Care Act could have been far bolder and done significantly more to reform the system and help their constituents had they been willing to work with Democrats back in 2009 vs. oppose them at literally every turn? (Because not only could the bill have addressed their concerns, when Democrats and Republicans quit fighting each other, they can actually afford to fight special interests.)

Beyond that, do you think they realize how many of the ACA’s problems were caused by the fact that they’ve spent the last eight years actively undermining the law and how many of those problems could have been resolved, long ago, had they not opposed any and every attempt to make the law better? They have to know that, right?

Well, I guess, maybe they do and maybe they don’t care, in which case maybe the irony of all ironies is that the their support for the ACHA really will help solve the Affordable Care Act’s problems…and by that I mean, I , personally, hope it will cost its supporters their seats and help elect representatives, who won’t – pardon my French fuck with their constituents’ health care just to score political points. Because I think we’d all be a lot better off if doing that had political costs.

But for the sake of the millions of Americans, who could be seriously harmed if this bill becomes law, I really hope the Republicans, who are so hellbent on passing it, will slow down long enough to consider a few questions.