January 4, 2017

Why Republicans Want to Kill Obamacare

When acting to “fix” something, it’s always a good idea to ask: What problem are we solving? Doing so forces you to consider ultimate objectives and how the status quo might be manipulated to achieve those objectives more fully.

The Republicans have been hell-bent on repealing the Affordable Care Act (aka Obamacare) for the better part of eight years. This objective has become an article of faith among Republicans that, seemingly, requires no justification. Republicans never explain what is wrong with the ACA or how repeal will make life better for Americans. Candidate Trump repeatedly pledged to dump the ACA but never, as far as I can tell, suggested why that would be a good thing. The 115th Congress is hardly a day old, and Republicans are already introducing legislation aimed at getting rid of the ACA.

Mike Pence
Mike Pence (photo by Gage Skidmore)
In the noon NPR newscast today, an audio clip was broadcast of Mike Pense explaining, if not what is wrong with the ACA, at least what Republican objectives are in their quest to eliminate it:
My message to members of Congress is that we are going to be in the promise-keeping business, and the first order of business is to keep our promise to repeal Obamacare and replace it with the kind of health care reform that will lower the cost of health insurance without growing the cost of government.
What do we see here? First, Republicans are going to deliver on their promise to repeal the ACA. But this begs the question. Why was that promise made in the first place? (I suspect the real answer is to stick it to President Obama, whom the Republicans hate with a passion. This begs the question again, and, for now anyway, I don’t want to touch that issue.)

Pence went on to enumerate Republican objectives for their fix. These suggest, at least implicitly, what is seen to be wrong with the ACA. And what are those objectives? They are (1) to lower the cost of insurance and (2) to prevent the cost of government from growing.

Consider the second objective. To put it generously, the Republican Party is the party of limited government. Any program that expands the scope of government, particularly if it costs money, is considered a bad program. (Spending more money on the military, however, is usually acceptable.) No consideration is given to the urgency of a program or whether government is an appropriate or most efficient actor to carry out its objectives. This is a knee-jerk reaction that exposes yet another article faith among members of the GOP. It is not a valid reason to attack the ACA.

What about the cost of insurance? The ACA was intended to decrease the cost of health insurance to make it more generally available. It has done that, allowing millions of people to afford insurance that had previously been unaffordable. Republicans are fond of pointing out that the cost of insurance under the ACA has been rising, but, even with increasing costs, more people have been able to buy health insurance.

The real objective of the ACA isn’t to make health insurance affordable, though Republican concern for corporate health might make that seem like a high-priority objective. The real objective of the ACA is, or should be, to deliver health care to everyone. The problem to be solved is the inability of so many citizens to access health care, largely due to economic circumstances. Health insurance is a means to an end, not the end itself. Pence seems unconcerned with this and with the fact that repealing the ACA has the potential to deny health care to millions of Americans.

Citizens who are not part of the extreme right wing of the GOP need to tell their legislators that the size of government is not a primary concern for them and that they want high-quality health care to be made available to everyone, regardless of income. It is a scandal that the number one cause of personal bankruptcies in this country is unaffortable medical bills.

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