By now, you’ve surely read and heard about the highly anticipated Congressional Budget Office “scoring” of the Trump-Ryan-Republican health care bill, or as they prefer to call it, the American Health Care Act.
(A small snotty aside here, just on the name of the thing: The previous health care overhaul, signed into law by then-President Obama, was officially named, “The Patient Protection and Affordable Care Act.” Republicans refused to ever call it that, and you have to admit, it is a mouthful of mush. Republicans dubbed the law “Obamacare” and proceeded to try to use it to discredit Obama by generally adding adjectives like “failing” and “disastrous” and a scheme that they soon announced was “imploding,” even as they did everything they could to sabotage and vilify it. So under the rule of turnabout is fair play, Democrats can call the new Republican bill anything they want, and I doubt very many of them are in the mood to call it the American Health Care Act.
Trump, who endorses the bill without reservation even though it breaks the clear promise he made to sign into law a new program that would provide health insurance to everyone at government expense, has asked that the law not be dubbed TrumpCare because, you know, he’s not the kind of guy who wants to stick his name on everything.)
Anyway, the CBO analysis projects that under the GOP proposal, the share of Americans who lack health insurance will almost immediately increase from 9.5 to 11.4 percent as soon as the new law takes effect, then shoot up within a year to 15 percent and continue rising to 18.6 percent over the next several years. (Here’s a fever chart of that CBO projection, courtesy of Vox.)
Personally, I believe that reducing the share of uninsured Americans was a worthy goal. Although there are many more ways to measure the quality of a health care system than just the share of the population with insurance, I think it’s a pretty big and important measure. I agree with Trump’s former position, in which he agreed with Bernie Sanders, that the goal should be coverage for all.
But it’s not the only way to measure such things. There’s also the quality of the care, and the cost of it. According to the CBO, the new TrumpRyanCare law will reduce costs — compared to the current trendlines — so much that the Republicans can afford to include in the bill a large tax cut to the rich (the reversal of the tax that was imposed under ObamaCare, to offset the cost of expanding health care) and still save money, on net, compared to projections of what ObamaCare would have cost over the next 10 years.
In fact, and although liberals may not attach as much importance to this than conservatives do, the CBO says that the implementation of TrumpRyanCare will reduce the deficit by about $337 billion over the next 10 years. (To be clear, that’s not to say that the national debt will come down, but that, if the CBO projection is correct, it will not go up as much as it otherwise would have. If you care about such things – and I actually do care about bending the curve of the debt-to-GDP ratio – deficits matter.)
If you were to ask which is a higher priority, to bend the debt curve or to reduce the ranks of the uninsured, I believe you would have a pretty good start on a question that would separate liberals and conservatives. Although if I was to let a little snottiness slip out, many conservatives are not real debt hawks when it comes to tax cuts or military spending, only when it comes to social spending.
But here’s the other thing – and here I’m bending over backward to understand the basics of the left-right dichotomy in modern America – conservatives think the key spectrum runs from more government to more freedom. Yet to liberal eyes, conservative “freedom” often equates with lower benefits to the needy tied to lower taxes on the rich. There, I’ve said it.
But heck, almost everyone cares about some kind of individual-freedom-versus-government-tyranny equation, don’t we? The Koch Brothers (whose motives are not pure), and the Tea Party and their allies in the House Freedom Caucus tend to attach a great deal of emphasis to this constant belief that if the government makes you do something, that’s the opposite of “freedom.” But you can call just about anything you favor a form of “freedom.” One of the famous “Four Freedoms” that Franklin D. Roosevelt outlined in 1941 was “Freedom from Want.”
Of course, it’s all an oversimplification. The government does a lot of things that secure our collective freedom. And “freedom,” if Janis Joplin had it right, is “just another word for nothing left to lose.” (I’m not sure Joplin was talking about health insurance.)
Which, amazingly enough, gets me to the strange point I started out toward a few paragraphs back: One of the things some freedom-loving conservatives hate most about Obamacare is the health care “mandate,” which requires those who don’t want to pay for health insurance to buy it anyway, or pay a fee (or a “tax” or a “penalty”).
Even though choosing to live without health insurance strikes me as a really bad choice, and even though my dyed-in-the-wool liberal soul is not truly offended by the health care “mandate,” if I try to understand the whole government-versus-freedom mindset, the mandate is a pretty strong example of taking away an individual’s cherished (and unwise) freedom-to-be-uninsured.
And in fact, the fact (okay it’s really a “projection”) in the CBO assessment that set me off on this whole strange rant was that: If the CBO is projecting correctly, the reason the uninsured rate will immediately shoot from the current 9.5 percent of Americans up to 15 percent if TrumpRyanCare is enacted is that the CBO believes that millions of Americans, if they don’t have a mandate to either get health insurance or pay a penalty, will just pay nothing and do what the Ayn Randers might call “self-insure,” which means they will choose to not have insurance and hope they don’t get sick or injured.
(Aside to my kids, if you are reading your dad today: Do not even think about doing this.)
So, does that mean it’s really about freedom? And, to the degree that it is, does that give you any more understanding of why to someone who analyzes everything through the “freedom” prism sees Obamacare as a step down the path toward “nanny-state tyranny” and TrumpRyanCare as a step back toward freedom?
Sometimes, when I see the pro and con sides arguing about this and other issues that one side sees as solidarity and helping the less-fortunate and the other side sees as meddling-creeping-government-tyranny, I wonder a little about – to paraphrase the philosopher Rodney King, “can’t we all just get along?”
At least right now, we can’t seem to.