(Jon Margolis writes political columns for VTDigger. His opinions are his own.)
[G]ov.-elect Phil Scott said the other day that he was confident Congress and the impending Trump administration would find “an off-ramp” to make sure that repeal of the Affordable Care Act would not deprive tens of thousands of Vermonters of health insurance.
Optimism is a useful trait in a governor. Self-delusion is not. Just where Scott’s confidence falls along that spectrum is an interesting question.
He’s hardly alone. At last count, Scott’s fellow Republicans in Congress have voted 60 times in the last six years to repeal “Obamacare” without ever voting on anything to replace it.
At the very least, this raises the question of whether replacing it is a viable option. Six years would seem long enough to come up with an alternative. Failure to do so indicates that perhaps there is no alternative.
There is. There is always an alternative. The rub, as Hamlet might have put it, comes from considering the consequences of the alternative. In this case, there would seem to be one of three possible consequences: (1) kick as many as 20 million Americans (and perhaps 100,000 Vermonters) out of the ranks of those with health insurance; (2) increase taxes on almost every working American; (3) some combination of (1) and (2).
This is theoretically viable but politically a non-starter. Some of those folks thrown off the health care rolls will have heart conditions, cancer and other chronic diseases. Without health insurance, they are far more likely to suffer and to die sooner than they would if they had health insurance. Everyone will know at least one or two of these people.
The average American may not be a big supporter of Obamacare. Even less is he or she a big supporter of suffering friends or relatives. A member of Congress who helps enact a policy that conspicuously increases the suffering of millions of people is likely to find him- or herself a former member of Congress fairly soon.
Perhaps this explains why congressional Republicans have voted only to repeal Obamacare, not to replace it.
It isn’t that there are no potential Republican replacement plans rattling around. There are several, at right-wing think tanks, in the computer files of some conservative professors, and even in at least one piece of proposed legislation – the Empowering Patients First Act, sponsored by none other than Rep. Tom Price, the Georgia congressman and physician nominated by President-elect Donald Trump to be the new secretary of health and human services.
Like most conservative health care proposals, Price’s relies on individual decisions and the market to provide health insurance. People would get tax credits to buy their own policies and as an incentive to create health savings accounts.
On their own, individual choice and free markets are desirable. But there’s a reason the Republicans in Congress never tried to pass Price’s bill: It would cover far fewer people than Obamacare does. If a plan such as Price’s were workable (meaning it would cover everyone at reasonable cost), it would exist somewhere in the world. It does not.
Until now, the Republicans didn’t have to worry about consequences. Had they passed Price’s proposal, Obama would have vetoed it, as he vetoed all their repeal bills. The Republicans had the luxury of having no responsibilities.
Those days are gone, so it’s no surprise that while Trump and GOP leaders in Congress can’t retreat from their pledge to “repeal and replace” Obamacare, now they’re talking about passing a repeal bill immediately, but making sure it doesn’t take effect until … later.
Giving them time to come up with the replacement they couldn’t come up with these last six years.
Whoever wonders whether this is realistic is wondering sensibly.
But let’s cut the congressional Republicans some slack here. They are hardly the only Americans who find it hard to accept a reality of the modern world: how interdependent, systemic and collective it is.
There is almost nothing individualistic about health care and the financing thereof, which depends not merely on a system but on an intricately intertwined network of systems, no part of which can be altered (much less abolished) without affecting all the others.
And while most components of these systems are in the private sector, the government has always (or at least about as long as anyone now alive can remember) played an important role. A plurality of Americans get their health insurance through their jobs. The employers pay most of the premiums, which is compensation for which the employee is not taxed.
That’s a government subsidy. Most working Americans are on a version of Medicaid.
Just as the deductibility of mortgage interest means that almost all home-owning Americans are in a version of public housing. And as it turns out, the interest deduction is only a smidgen of the government’s support for the private housing market. The entire real estate industry as it exists today is a government creation.
So is the entire food industry. Americans who eat food (and do not produce all their own) should understand that it comes to them via an increasingly consolidated, centralized, elaborately engineered system regulated and subsidized by the government. Without those regulations and subsidies, the food would not be as plentiful, as inexpensive, or as safe to eat.
In a society which (to its credit) honors the individual and the market, it is tempting to ignore these realities as a means of denying them. This temptation is not limited to Republicans, though it might be stronger among them.
The Republican governor-to-be, who does not share the antipathy to the health care law of his party’s congressional wing, seems convinced that reality will conquer ideology in Washington. Either way, he said, Vermont will “make sure” that thousands are not denied health coverage.
If he’s wrong – if ideology conquers reality – that could cost tens of millions of dollars, which Vermont would be hard-pressed to raise. There are always alternatives. When it comes to health care, there are two possible alternatives to Obamacare. One is the kind of truly universal system most of the prosperous world enjoys. The other is a whole lot of people without health insurance.
(Note: Jon Margolis’ Nov. 15 column on the election misattributed a quote from historian-journalist Neal Gabler, writing on Bill Moyers’ website Moyers & Company. Thanks to reader Keith Morgan for noticing.)
