Health-care redo: After CBO analysis, House Republicans have much to answer for

REUTERS/Shannon Stapleton
Demonstrators and health-care activists rallying before the visit of Speaker Paul Ryan at the Success Academy 1 charter school in Harlem on May 9.

Right on schedule, the Congressional Budget Office Wednesday released its analysis of the version of the American Health Care Act that passed the U.S. House on May 4.

I said at the time and I still feel that there was no need for the House to rush the bill through without waiting for the CBO’s analysis of what it would cost and what it would do for whom and to whom.

The nonpartisan CBO cannot truly see the future in all its complexity, nor can anyone else. But the CBO is the best we have and there is something shady, shameful and dishonest about the House Republicans’ decision to push the bill through without benefit of the CBO analysis. The CBO works for Congress and its job is to give its members this kind of analysis.

The CBO found that this version of the AHCA (which I prefer to call Trump/RyanCare just as Republicans prefer to call the Affordable Care Act “Obamacare”) will likely cause 14 million additional Americans to become uninsured within a year and 23 million additional Americans to become uninsured over the next 10 years.

Savings offset by tax cut

Various money-saving provisions of the law will reduce the cumulative federal deficit by $119 billion over the same 10-year period, the CBO found. Actually, that’s not quite right. The money-saving provisions will cut spending by more than $1 trillion, but most of that trillion is offset by tax cuts of almost a trillion dollars, tax cuts that will disproportionately benefit wealthy Americans.

(On that point, I’ll just pass along the statement, sent out Wednesday, by a bunch of wealthy liberals, who call themselves “The Patriotic Millionaires,” who said:

The CBO score proves what we already knew: Trumpcare is a tax cut for millionaires disguised as a health care bill.

I agree, and would add that if the Republicans who support this bill (no Democrats do) cared as much as they often claim to care about the size of the federal deficit and debt, they had a chance to prove it in this bill by leaving the high-end taxes in place and reducing the debt by more than $1 trillion over the decade ahead.)

The 23-million-person reduction in the number of Americans who are covered with insurance is a slight improvement over the previous version of the bill, the one that was pulled down because its sponsors knew it didn’t have the votes to pass the House. That one, according CBO, would have produced an increase of 24 million in the ranks of the uninsured. I would call that a very small improvement.

In fairness, I should mention a favorite Republican talking point on the increase of uninsured Americans: Many of the uninsured, the CBO projects, will choose not to be insured once the new law removes the penalty that the current law imposes on the uninsured, the so-called mandate.

The cost of premiums

Aside from the rising share of uninsured Americans, the other biggest deal is what the House health care bill might do to the cost of premiums of some of those who remain insured. As I’ve mentioned before, Trump/RyanCare neither repeals nor really replaces Obamacare. It just amends it, mostly in ways that are beneficial to the rich, the healthy and the insurance industry. The House-passed version of Trump/RyanCare offers states the right to opt out of various provisions of ObamaCare, including the way the current law tries to protect those with pre-existing conditions.

MinnPost’s Washington guy, Sam Brodey, made a heroic effort to explain this two weeks ago. I highly recommend it. But, to cut to the chase, as part of its CBO-report coverage, the Washington Post said yesterday that, depending on your age and what your state opts out of, some people (especially those aged 60-64) could see premiums that will rise from an annual out-of-pocket cost of $1,700 to a cost of $13,600 or $16,100, or a maximum increase of 850 percent. Here’s that Post piece.

There are a million — or maybe it’s a zillion — more details that could be discussed about Trump/RyanCare. I’ll just mention one of my favorites:

As a candidate, Donald Trump said that the health care plan that he would sign as president would cover “everybody,” and that for those who couldn’t afford it “the government will pay for it.”

As you recall from the famous “Schoolhouse Rock” cartoon about how we make laws in America, the House bill awaits Senate action. Although Republicans have a 52-48 majority in the Senate, there is no handicapper who believes the Senate will pass the House bill as is.

“I don’t know how we get to 50 at the moment,” Majority Leader Mitch McConnell told Reuters on Wednesday. “But that’s the goal.”

The full 33-page CBO report (plus a few pages of tables) is available here.

Comments (26)

  1. Submitted by Ray Schoch on 05/25/2017 - 09:39 am.

    No one should be surprised

    Nothing Paul Ryan has done (as opposed to some things he has said) in his years in Congress suggests that this “health plan” would take anything other than its current shape. Should it pass the Senate in largely the same form it’s in now, it would be, essentially, the acid test of Mr. Trump’s alleged character, given his many pronouncements during the campaign about how awful the ACA is and how “his” (actually, Ryan’s) plan would cover everybody and be subsidized for those who couldn’t afford it. I don’t expect it to get through the Senate, but stranger things have happened, and because it’s so easily compared to Trumpian campaign rhetoric, I’d be (mildly) surprised if 45 voluntarily proved to the populace and the world that he’s a bald-faced liar by signing it. Being a liar doesn’t bother him, apparently, but doing so in this context might hurt his “brand,” and that, I think, •would* bother him, since he’s milking the presidency for every dollar he can grab.

    All that aside, what we have in this bill is a clear statement of current Republican ideology and how it will be implemented. The Republican Party has been captured by an ideology that’s ethically and intellectually bankrupt, and largely incapable of governing. As the wealthy liberals Eric has quoted said so well, the AHCA is a tax cut for the wealthy disguised as a health care bill. It’s not only a tax cut for those who don’t need one, it also provides financial assistance to health insurers, whose bottom lines don’t generally need assistance, either. When costs begin to erode their bottom line, health insurers simply leave the health insurance market in a given state (you can pick your own example) to concentrate on more profitable areas.

    Jason Lewis had already proven himself to be in the thrall of right wing radicalism before he was elected, but Erik Paulsen has presented himself as a “sensible conservative.” His vote for this bill ought to shatter that image permanently, and, aside from the folksy images projected in his campaign ads, shows that, while he may care about his own family, he certainly doesn’t care about yours. Much the same could be said of Tom Emmer.

    • Submitted by Sean Olsen on 05/25/2017 - 10:23 am.

      The problem with Trump on this issue (and many others) is that he has no real policy knowledge or preference because his life isn’t going to be materially impacted one way or the other. To him, the goal is to pass a bill to be able to claim that he fulfilled a promise and lived up to his brand as a “dealmaker”.

      As for Erik Paulsen, he’s liked to claim he’s a numbers guy. Well, these numbers are painful. The budget savings here represent about 0.3% of the budget and it would kick 7% of the country off of health insurance altogether and stick it to the poorest and sickest Americans.

    • Submitted by Ilya Gutman on 05/26/2017 - 07:06 am.

      Please elaborate

      “The Republican Party has been captured by an ideology that’s ethically and intellectually bankrupt, and largely incapable of governing.” Can you please elaborate?

  2. Submitted by Tom Christensen on 05/25/2017 - 09:42 am.

    Not a single clue on how to lead

    The Republican Party still doesn’t have a clue on how to lead ALL of the people. The much promised Repeal and Replace of Obamacare was supposed to happen on day one of the Trump Presidency. Trumpcare is the perfect example of the Republican’s only working for the people they select. Trumpcare is heartless politics as they play with American lives to suit their own goals of feeding the wealthy. The Republican’s were the Obstruction Party so long they’ve forgotten how to govern. They continue to work to keep us as the Divided States of America rather than the United States of America. The only way the healthcare problem will be truly fixed is if the two party’s choose to work together. Both party’s have to realize they won’t get all they want and they will have to accept somethings they don’t want. It’s called democracy. Poison pill politics and political claptrap is what congress has evolved to, which helps very few. We need to send people to Washington that want to make positive changes to get our political system back on track to serve ALL the people.

  3. Submitted by Paul Brandon on 05/25/2017 - 10:31 am.

    Shouldn’t it be called

    the ‘We Don’t Care’ Act?

  4. Submitted by Tom Christensen on 05/25/2017 - 10:56 am.

    Clueless McConnell and Ryan

    Mitch McConnell stated today he is not sure how to get to 50 votes in the Senate for healthcare. First of all he has to want to get to 50 votes. The answer is to work with the other side of the aisle and be flexible. It isn’t rocket science. In reality the Republicans don’t even need the Democrats to get to 50 votes. It is McConnell’s own party that is the cause of his failed leadership. Paul Ryan’s failed leadership led him to state yesterday he doesn’t know what to do about healthcare either. Paul, see answer above it applies to you as well. It is utterly dumbfounding that the party that tried to repeal Obamacare over 70 times over 8 years still doesn’t have a viable plan. Healthcare is going to be the Republican Party’s political albatross of their own making. It’s called another totally self inflicted wound. They are already really good at self inflicted wounds.

  5. Submitted by Daniel Gardner on 05/25/2017 - 11:36 am.

    Health Care Legislation

    Come on, folks. Can anyone be surprised that the result of the new health care act – from the Republican Party – is anything but what was delivered. Let’s cut the deficit (sure?!?) on the backs of the poor, middle class and seniors. This is who the electing public put into office. Now we shall reap the results of their work . . . . Come on, folks.

  6. Submitted by Connie Sullivan on 05/25/2017 - 11:42 am.

    McConnell’s goal is wrong.

    What he should be working toward is a decent, caring health care insurance plan that truly helps Americans at the bottom, near the bottom, and near the middle of the economic scale. Not just some abstract “50 votes.”

    For what? Donald Trump doesn’t understand health care insurance and has admitted that he doesn’t. He has made, therefore, a bunch of empty promises to his supporters, who don’t realize that this businessman has never had even to READ an insurance policy, to know what’s covered and what’s not covered, in his health care. All Trump wants is a deal. Any deal.

    One should begin with the problem, which is what Obamacare did: too many millions of Americans lack effective health care, or any health care, and have to rely on crisis-caused emergency charity hospital treatments as their lives implode with health problems. Why must America continue to deny health care to the poor, the sick, and the elderly, and to children?

    That’s what grabs me about this problem: that Republicans don’t care who gets sick, as long as nobody has to pay anything to take care of those who get sick.The heartlessness is stunning.

  7. Submitted by Noel Martinson on 05/25/2017 - 01:33 pm.

    When labels are lies we need to stop using the label

    Even if we going on to to explain that the label is a lie, we still reinforce the misleading sound bite first and therefore the context of the discussion. In this case we spend more time discussing the short comings of the bill in terms of health care rather than the short comings it has as a tax reform bill.

    When viewed from the perspective of a tax reform bill we may find ourselves focusing our discussion on the merits of giving the wealthy a tax cut and whether we should repeal/replace Obamacare in order to pay for it. That, I think, is a much harder (and more honest!) sell than the way the Republicans have framed it.

    It is basically a “follow the money” approach. Before getting bogged down in who gets hurt and how much, ask first who benefits and whether delivering such a benefit is worth inflicting any pain in the first place.

    Until this bill is completely overhauled so as to make the primary beneficiaries those who are struggling to pay for or receive adequate healthcare it cannot honestly be called a health care bill.
    So let’s stop calling it one.

  8. Submitted by Ron Gotzman on 05/25/2017 - 01:49 pm.

    Obamacare a “huge” success???

    I am so glad to hear the ringing endorsement of Obamacare from Mr. Black.

    As Trump stated – politically – it may be best to have Obamacare continue to fail and blame this colossal failure and the Democrats. Trump should say “you can keep your Obamacare.”

    The Dems will have much to answer for – but not from the media. The media will blame Bush or the Russians as Obamacare withers on the vine.

    • Submitted by Tom Christensen on 05/25/2017 - 02:16 pm.

      The Republicans have total control

      The Republicans don’t need a single Democrat to do any of their agenda. It isn’t the Democrats that are stopping the Republicans. Apparently the Republicans don’t have ANY answers. Trump signed the executive order to repeal Obamacare. Now the Republicans own what was called Obamacare and is now called TRUMPCARE. Welcome to TRUMPCARE.

    • Submitted by David LaPorte on 05/25/2017 - 05:35 pm.

      The opposite of helping

      If the Affordable Care Act fails, the blame will belong to the Republicans. Standard and Poor’s reported a few weeks ago that the exchanges were stabilizing, that participating insurance companies should break even this year and make a profit in 2018.

      Except that the Republicans have been busy sabotaging it.

      Republican Senator Marco Rubio crippled the risk corridors in late 2015. The risk corridors are a strategy to share the risk among participating health insurance companies. If an insurance company covered more than their share of sick people, the government would subsidize them. These subsidies were funded by insurance companies that got more than their share of healthy people. Shared risk was supposed to stabilized the markets, until Marco undermined it.

      Early in his presidency, Trump pulled the advertising for the ACA during the last weeks before the enrollment deadline. He eventually restored it, but a lot of damage was done.

      Now Trump is threatening to withhold the subsidies that the insurance companies were counting on receiving. He’s delayed the decision until August, giving the insurance companies very little time to roll out their 2018 plans.

      And there is a regular drumbeat of pronouncements of death spirals for the ACA from Trump and Ryan. Apparently, they know more about finance than Standard and Poor’s.

      The ACA is far from perfect, but what the Republicans are doing is the opposite of helping.

    • Submitted by Dennis Wagner on 05/25/2017 - 09:51 pm.

      Well

      Actually I agree with Ron!

      Let it Rip………………….
      When you look at the unhealthy states (They tend to be red)
      http://www.businessinsider.com/unhealthiest-states-2016-12,
      When you look at tax takers vs tax payers, again the preponderance is red takes, blue pays:
      https://www.theatlantic.com/business/archive/2014/05/which-states-are-givers-and-which-are-takers/361668/
      Government workers/burden as a % of the states employed people, again red states tend to be higher than blue.
      http://www.governing.com/gov-data/public-workforce-salaries/states-most-government-workers-public-employees-by-job-type.html

      I think it is high time that these red states get what they voted for! Cut the budget with that Trump Axe, and give all the praise to Trump, the Republican Senate, and Republican Congress 100%.

      Give them red state folks what they voted for, us blue states will all be the better off for it! Aren’t Minnesotans tired of being over taxed and sending those tax $ to Mississippi, S. Carolina, Alabama etc?

      • Submitted by Tom Karas on 05/27/2017 - 08:21 am.

        more fun with maps

        The comparison of red/blue states is even more stark when you Google “states with the highest percentage of – illiteracy, obesity, high school drop out rate, adults who smoke, …” and the list does go on as you begin to see the obvious. Not pushing stereotypes, just analyzing demographics which of course are based on factual reporting. Oppps, sorry to mention facts, which like the scientific method are now open to reconsideration in the present state of affairs.
        Just get everyone out to vote, that will fix this mess.

  9. Submitted by Joel Stegner on 05/25/2017 - 02:01 pm.

    What is next

    Frankly this bill is not going to pass the Senate, so the real question is what is next. Does anyone really think the concealed tax cuts are “health reform?”

    My Republican Congressman in response to my question regarding the reasons for his vote talked about making use of creativity of states to create a better system. If one accepts the states may have useful ideas – which are not evident in the bill, where does one look?

    Trump has said everyone who wants it should have healthcare coverage. Strange, given how the bill will take away coverage from so many who people who will literally get sick and die without it, but let’s use that standard as top priority.

    States serious about universal coverage should be the first places to look. That wasn’t the only thing Trump promised – he also wants lower costs and better care, both in terms of clinically effective care and great patient outcome. Don’t really see how the bill addresses any of that

    Representative Paulsen not to mention Representatives Lewis and Emmer, where is such as example of uniformly superior care? Please look straight down next time you are back to Minnesota, and open your eyes to what Senators Klobuchar and Franken have already discussed.

    We really want to look at the best of the best for our future national healthcare system. That is the Minnesota Medical Model of integrated care, in which innovation moved quickly from academic and industry to clinical settings.

    I am including our payers, who along which the rest of our system rate better than average at providing access to care at a moderate cost. Our active insurance market place rewards quality clinical care in a way not always seen elsewhere.

    As in most things life is good in Minnesota and as our national system needs work to drive out excess profits, paperwork and preventable illness, let’s not allow the many conservative states that do it poorly and show little interest getting better taking the country in the wrong direction.

    • Submitted by Frank Phelan on 05/26/2017 - 12:35 pm.

      Oh, NOW They Like Local Control???

      So when it comes to healthcare, the GOP likes local control and creativity. But when it comes to the minimum wage and things as mundane as plastic bags, they very much do not like local control and creativity.

      Now I know how Jim Hightower felt when he said that no matter how cynical you get, it’s almost impossible to keep up.

      Do Republican politicians get some sort of brain transplant when they move from state legislatures to the Congress?

  10. Submitted by Neal Rovick on 05/25/2017 - 03:50 pm.

    There is certain amount of sour humor in the fact that the Republican party is locked in an internal debate as to whether to make the lives of millions worse or make them even worser.

    You have to realize that Trump compromised with the far-right to make an even worse plan.

    And that is the dilemma of a party that has demagogued itself into the far right weeds of policy riding on the ignorance of the voters that were hyped into electing them.

    The question for the Republican party now is, “How badly can we screw our supporters by carrying out our promised policies and still stay in office after the next election ?”.

    That, unfortunately, is the only rein on a party that controls all 3 branches of government.

    It should be clear to all the Trump really doesn’t give a damn about policy, just getting a “deal”.

  11. Submitted by Ilya Gutman on 05/26/2017 - 07:09 am.

    Thank you

    I want to start with the positive and thank Mr. Black for mentioning that many of those who will lose coverage will do it on their own will. My wild guess is that most other liberal writers do not mention this small detail.

    Now a few more points.

    First, that tax that goes back to those super rich, Republicans believe that they would invest that money and that would actually bring in more in taxes. True or false – is another matter but that is the intent so one cannot say that Republicans abandon their idea to cut the deficit.

    Second, all those “patriotic millionaires” have full right to give more money to the government or create their own medical system that would help the poor. So no matter what, those “wealthy liberals” still want to take money from someone else.

    Third, while we can believe the CBO, we cannot believe the Washington Post so when they project the premium costs, I remain highly skeptical. Plus, who has an annual out of pocket cost of $1,700 – I’d like to see those people.

    And finally, think of a family which badly needs a vacation after going for many years without one. So a father promises everyone a two week luxury cruise in the Mediterranean with an extra week after that on the beaches of Greece. However, later his wife realizes that they cannot afford all this so she suggests a week in the Disneyworld… and is roundly condemned by all kids for breaking the promises and not letting anyone have a good time. But, obviously, if Disneyworld were what he offered from the very beginning, everyone would have been happy.

    Obamacare is not sustainable due to huge premiums and deductibles and more and more companies pulling out of the market. On the other hand, if Republicans offered this plan 10 years ago, everyone would have been delighted. So let’s stop being irrational here…

    • Submitted by Neal Rovick on 05/26/2017 - 09:25 am.

      Sorry Ilya–your luxury cruise vs Disneyworld vacations doesn’t work.

      You really can die from lack of healthcare–recent studies show as much as a 20 year difference in life expectancy depending on where you live, due in part to access to affordable health care. So early, preventable deaths do occur.

      In the end, the true issue is whether you think meaningful access to healthcare is a right or a privilege.

      Whatever other issues of personal responsibility, cost and other logistic elements that are brought up by “conservatives”, you have to recognize that every other developed country has better access at a lower cost. Even Trump said so several times to the Australian PM. You also have to recognize that the fragmented system of a variety of insurers and public payments contribute in a large way to the overly-high costs–every study points to a 1/3 of healthcare spending being eaten up in the insurance process.

      Remember the “death panels” coming from Obamacare ? How about the very real denial of affordable coverage under Trumpdontcare ? That’s a real “death panel”–already proven to exist.

      • Submitted by Ilya Gutman on 05/27/2017 - 09:01 am.

        The only rights we have are the ones from the Constitution; since health care is not mentioned there, it is not a right and no one can demand it. Now, having said that, I am not against government provided universal healthcare provided some personal responsibilities are built in i.e. smokers have higher co-pays and deductible and vaccination is mandatory and those who choose not to vaccinate their kids should lose coverage for themselves and the kids when they grow up should plus kids should not be allowed to attend any public schools). So my post was not about healthcare but about politics surrounding it.But I am not sure the way it is done in other countries is the best way – they do not provide a better care at a lower cost; unfortunately, it is myth that exclude some other things to make that claim…

        • Submitted by Paul Brandon on 05/27/2017 - 10:01 pm.

          Read it

          “The Constitution of the United States
          PREAMBLE

          We, the people of the United States, in order to form a more perfect Union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”

          “Promote the general welfare” certainly includes health care.

          • Submitted by Ilya Gutman on 05/29/2017 - 09:02 am.

            Shelter, food, clothing…

            If, in your mind, the Preamble of the Constitution “certainly includes health care,” it then clearly guarantee free shelter, food, and clothing, all of which are definitely part of the “welfare.”

  12. Submitted by Jon Kingstad on 05/26/2017 - 10:54 am.

    Moral and intellectual bankruptcy

    I completely agree with Mr. Schoch’s comment especially about the GOP’s present moral (or ethical) and intellectual bankruptcy. Having succeeded in becoming a populist party, it is now engaged in an internal struggle attempting to reconcile two or maybe more irreconcilable ideas. Perhaps that it a feature of the two party system.

    The ACA was far from perfect but it was never intended to be an end game. It was intended as a first move toward a more universal health care system like Medicare. Most people today below 65 are covered by employment based health insurance, which, because of access to larger pools, keeps premiums, co-pays and deductibles lower for employers and employees. It’s the large population of those below 65 for whom the ACA was intended to benefit. As Mr. Laporte pointed out, the GOP sabotaged that plan. But many of the people with no affordable access to health care (and health care insurance) are children.

    One way of framing the debate is between those who believe health care is a “right” and not just a special privilege for those who can afford it. Which is only another way of saying that the government of an advanced industrialized nation has a duty to provide health care for its people. I believe that industrialization which has elevated the wealth of the country has also so exposed us all to health hazards and risks that cause illness, e.g. cancer from processed foods or water contaminated by PCBs and mercury,that this is a morally obligation. The problem is in pooling the risks and evening the costs across a wide number of people and then paying for it. Either through premiums, deductibles and co-pays or in taxes which are in the final analysis about the same thing. Both take money from each of us and pay for the rest of us, including ourselves, when we’re sick. Everyone gets sick and only some us us are fortunate enough not to get so sick as to bankrupt us.

    Medicare took care of the biggest “pre-existing condition”- old age and the health problems which accompany it-for the 65 and older part of the population. The next step needs to extend that idea to cover pre-existing conditions for the under 65 population. The GOP has to get out of the trap of thinking that government is the enemy of the people and start acting like it can be our friend.

  13. Submitted by Misty Martin on 05/26/2017 - 11:44 am.

    As a percentage of the sick and poor, I am heartsick.

    My husband lost his job over 2 years ago now, and as he was working while really not able to do so – he has diabetes and other ailments – we lost our healthcare coverage through his company, and have not been able to purchase any since. We have had to rely on our local Access Health facility, but we still have to pay a lot out-of-pocket, including his diabetes prescriptions. I work, but what little I make doesn’t cover all of our bills, and some months, it’s literally, do we eat or pay the mortgage or buy medicine?

    The fact that this healthcare plan would not cover pre-existing conditions leaves me with little hope. I, too, have some medical needs that should be addressed, but I have had to put all of those on the back burner for now. My husband has applied for his SSA disability, and has had his hearing, but to date, we have heard nothing. Now as the new budget that Trump and the others in his administration are trying to pass has major cuts, including those trying to receive SSA DIS, I am disheartened and downright scared of our future.

    Maybe I should try and save my pennies and buy that new book that Ivanka Trump wrote for “working mothers”. I’m sure that there are real tidbits in there I could use. No wait . . . I don’t have a rich, influential daddy. I guess there’s not much help in there for me.

  14. Submitted by Jon Kingstad on 05/26/2017 - 04:22 pm.

    Not “morally (sic)”

    but rather “is a moral obligation”

  15. Submitted by Paul Udstrand on 05/27/2017 - 10:15 am.

    Republicans AND Democrats

    One of the huge failings in the last election was the Democratic denial regarding an ongoing health care crises. It’s been said that Obamacare was supposed to be an interim solution on the way towards single payer, but I’m not at all sure that we have agreement on that. Clinton and many others in the Democratic Party seemed to think that Obamacare was about as good as we could do and they rejected Sanders’s call for expanded Medicare out of hand. This is weird because the majority of Americans want MFA (Medicare For All) and MFA is the only program can control costs, and provide universal coverage.

    The Republicans on the other hand are simply dealing with a host of chickens that have been roosting among the cobwebs of their own intellects for decades. In my lifetime I’ve never seen Republicans make a priority out any legitimate issue. (Remember- the big issue Reagan had with Jimmy Carter was the Panama Canal). From praying in public schools to WMDs Republicans have made a career out of manufacturing crises rather than resolving real problems. The advantage of manufactured crises is that you don’t really have to provide solutions or work anything out, it doesn’t matter if you fail to solve an imaginary problem. The disadvantage is that after decades of distancing themselves from reality Republicans have dumbed themselves down to the point where even moderately complex issues are beyond their grasp. Nobody knew how complex health care was.

    Even the “smart” people among the Republicans have not a clue. That Paul Ryan actually thought Republicans could repeal and replace Obamacare without producing a plan of their own betrays a level of stupidity that permeates the Party. The problem is that Republicans A) Have never believed that health care was a real problem, they think the health care crises is an imaginary crises, while voter fraud is a REAL problem . B) Have no understanding whatsoever regarding the nature of health care or the problems associated with it. And C) Completely lack any of the critical intellectual skills required to recognize much less resolve legitimate problems be they basic or complex. Its putting a bunch of dogs in a room full of musical instruments and expecting they will form an orchestra. Republicans have discovered after decades that health care is actually a real concern, and they simply have not the skills or in the inclination to cope with REAL problems or issues, much less one as complex as affordable health care. They actually think raising premiums will discipline people into being healthy, well at least poor people- wealthy people can be as undisciplined as they want and still get health care.

    Republican budgets and plans in general are riddled with immorality because morality itself is a complex issue.

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