I spent a good part of my youth in a small town in southwest Virginia. And in my neighborhood, many families had dogs, and virtually none of us had fences. So all of the kids grew up with each other’s pets. In many ways, the dogs belonged to all of us.
It was a sad day when “Bengal” got hit by a car. He technically wasn’t my dog, but my yard was part of his chase path whenever someone was driving through. As a grown up, I know that these tragedies happen to dogs who can’t stop chasing cars. For a ten year old boy though, as I was when this life altering event occurred, I predictably blamed the car.
In today’s exercise in analogies, the “car” is the Affordable Car Act. “Bengal the dog” is Congress.
Since the ACA passed, the political scene has been inundated with “repeal Obamacare” mantras by its partisan opponents. For six solid years, we have been watching Republicans chase that car as if catching it would pay great dividends. In some circles, as detailed on late night TV, the public has been brainwashed into believing that “Obamacare” is bad, but the “Affordable Care Act” is good. It has become that confusing to Americans.
Whenever I find myself discussing the politics of our national health care situation, I always remind people of the market the ACA replaced, and why. For the decade leading up to passage of the ACA, insurance costs were significantly outpacing income growth. Niraj Chokshi reported for the Washington Post nearly three years ago that in 2003, the average annual premium was about 15 percent of the median household income for non-seniors. By 2012, it had risen to 22 percent. That is an economically intolerable trend.
Many in the public now seem to believe that the ACA was just some ill-advised idea which was born out of a liberal think tank for no apparent reason. That is nonsense of course. It was created in response to a healthcare and insurance market in crisis. For purposes of addressing the crisis from which it was born, it has been an undeniable success.
Paying for it, like virtually anything else, has been understandably unpopular. And there is no solution that eliminates that burden.
Speaker of the House Paul Ryan spoke this week about how eliminating the personal mandate provision of the ACA, and replacing it with a tax credit is a fundamental strategy of his plan. I understand the theory: customers will take the credit and choose the insurance plan they want. This competitive choice will drive down prices. Of course, choosing no insurance will likely be a popular option.
Americans choosing not to buy insurance blows up this foundational part of the GOP plan. No healthcare insurance plans can operate without healthy customers buying it. Those healthy customers are the ones who finance the unhealthy customers. And giving a healthy person a tax credit and a choice of what to buy with it, will result in fewer people insured.
Prior to 2013, as many as thirty percent of middle income people were uninsured or underinsured in a handful of states, Texas among them. Imagine what those people would do with a tax credit given to them at that time. Would the healthy people in that group have spent it on better or more insurance? Or would they have spent it on any number of other things like food, college tuition or retirement planning?
Health insurance simply cannot work without healthy customers paying into the pool, and the healthy are the first ones to feel like it is wasted money when they don’t immediately need the coverage. That is just basic capitalism. Unhealthy customers rush to buy insurance because they receive more in return than their premiums cost.
This basic fact is being overlooked by the unspecific and slogan type “solutions” being pitched today.
The election results enabled Republicans to finally catch the car they have been chasing for the last six years. For that entire time, they never really had to plan for what they would do when this day finally came. There is no easily understandable and obvious upgrade to be made for those who have bought the “repeal and replace Obamacare” campaign cry. It is a true political quandary.
One of the worst things for “repealers” though is the absence of that bogeyman. When life has not measurably improved for Americans over the next two years, and President Obama is no longer here to blame, what will they do?
Hopefully by then they will have learned to keep a safe distance from the cars they chase. Otherwise they may go the political equivalent of the route of Bengal the dog, may his soul forever Rest In Peace.