Trumpcare

Just a quick note on yesterday’s vote in the House to repeal and replace Obamacare:

• It won’t pass the Senate
• That means another version will emerge from the Senate
• The two versions will then have to be “reconciled” and voted on again
• The current House version will eliminate coverage for about 20 million people
• It will eviscerate Medicaid
• It will increase costs for the elderly and the sick
• It tries to offset this by including subsidies that introduces significant issues of moral hazard into the system
• It will allow insurance companies to offer less comprehensive plans [which is how it aims to reduce premiums prices]
• It eliminates the “mandate” and thus increases the risk of adverse selection
• It thus destabilizes the market
• It was voted on without any serious debate — many Republicans voting in support haven’t yet read what they voted for

All in all this was purely a symbolic vote so that the Republicans can say they followed through on their promise to repeal Obamacare. This is significant because it has been a seven year gripe of the Republicans that Obamacare wasn’t sufficiently discussed. Hypocrisy, apparently, has no end in Ryan’s world. It is shockingly bad as piece of public policy — it is cavalier with the sick and elderly. It fails to meet even the lowest of goals Trump campaigned on.

I continue to believe that America will stumble towards its own version of universal healthcare — the logic and economics of health care demands that it does. This awful bill, for instance, doesn’t re-set the system back to what it was before Obamacare. So it is a stutter along the way.

The Republicans are losing the moral and ideological argument, but the American political system, designed as it is to slow down change, and riddled as it is with moneyed interests, makes it difficult to get anywhere in a straight line.

In any case: Trumpcare is a colossal electoral gift to the Democrats in 2018. Already the pundits have moved a large number of the vulnerable Republican seats in the House into the win column for the Democrats. And that is why Trumpcare is a long way from becoming law. The symbolic vote is over. Now the hard part of legislating begins. It is by no means clear that the reconciliation process can produce a bill enough people agree on.

So repeal and replace might well die yet.