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Interesting. Paul Krugman, in response to the newly unveiledTrump-Republican American Health Care Act (AHCA), lays out his support for preserving the private health insurance system as clear as day:
The structure of the Affordable Care Act comes out of a straightforward analysis of the logic of coverage. If you want to make health insurance available and affordable for almost everyone, regardless of income or health status, and you want to do this through private insurers rather than simply have single-payer (empahasis added), you have to do three things:
1/ Regulate insurers so they can’t refuse or charge high premiums to people with preexisting conditions
2/ Impose some penalty on people who don’t buy insurance, to induce healthy people to sign up and provide a workable risk pool
3/ Subsidize premiums so that lower-income households can afford insurance
After trumpeting (sorry) the usual private health insurer-Democratic Party PR shtick about expanding the limited numbers of those who were covered by the increasingly unaffordable (higher premiums and deductables), and unacessible (shrinking provider network) Obamacare private health insurance, Krugman comes out with the truth:
… the GOP proposal basically accepts the logic of Obamacare. It retains insurer regulation to prevent exclusion of people with preexisting conditions. It imposes a penalty on those who don’t buy insurance while healthy. And it offers tax credits to help people buy insurance. Conservatives calling the plan Obamacare 2.0 definitely have a point.
Voala: the Trump-Republican AHCA health insurance plan is nothing more than a worse version of what is essentially Obamacare, “Obamacare Lite.”
Krugman’s and the Democratic Party’s framing of the issue, which starts from the premise that the central position of the private health insurers in the health care system must be preserved, is precisely why we’re so quickly slipping backwards on health care (and everything else, for that matter). Democratic Party and some left supporters of the Obamacare argued that the ACA was both “a step in the right direction” and “all that’s realistically possible” given the current political situation. Now, by Krugman’s rightful admission, Trumpcare is really just a half step back from the Democrat’s “Unaffordable Care Act,” the UCA.
The problem isn’t whether the UCA (Obamacare) is a step forward or the AHCA (Trumpcare) a half step back from the corrupt, ineffective, and inefficient US private health insurance system. It’s not whether the glass is “half full or half empty.” The common Democratic-Republican approach to health care “reform,” with its inviolable premise of preserving the rapidly collapsing private health insurance system, is a glass half (or quarter) full of disgusting, undrinkable, dirty, and highly lethal water.
Despite corporate press reports of the recent increasing popularity of the UCA (Obamacare), in fact poor and working people can smell a rat and aren’t stupid. They know that if you are really poor, even a subsidized Bronze Obamacare plan, with its $6,000 – $11,000 deductibles and a shrinking provider network, does not mean you have access to quality affordable health care. And if you are “middle class” (i.e., barely scaping by) and don’t qualify for a an AHCA tax break or a direct UCA subsidy, you will end up paying (should you actually get sick and need to use your health insurance) as much as $10,000 to $25,000 a year in premiums on top of the $6,000 – $11,000 cost of services in deductibles!
This is precisely the problem. Once you get past the “lesser evilism, half full” framing of the issue, you can see that the Democratic Party’s approach to fighting for health care “reform” has been a political disaster. Obamacare was a such an empty, unworkable, overly complicated, obviously reactionary boondoggle for the private insurers that Trump and the Republican’s didn’t hesitate to attack it head on and move immediately to repeal it. The Trump-Republican’s Obamare Lite AHCA, by preserving some of the key parts of Obamacare, will effectively blunt whatever opposition there is to the repeal of the UCA. Think about it: Trump and the Republicans would never dare mount such a direct attack on Medicare, the last meaningful health care reform from before the neoliberal era. The lesser evilism, “take a half-step in the wrong direction” neoliberal Obamacare UCA approach to health care “reform” is a big part of the reason why the Democrats were beaten by Trump in the last election.
It’s time to break the cycle of lesser evilism in Left politics. “Defend the ACA” is an ineffective political slogan. A better, really the only effective political approach is: build a grass roots, militant movement for Single Payer Now!
Allan Miller lives in the San Francisco Bay Area leftydatageek at gmail.com