How many legs does the ACA have?
The news media keeps harping that the Republican congress has no replacement for the ACA. This is untrue, and they know it, or they should. The problem is not that there is no replacement for the ACA. Congress has already voted on several replacements which were vetoed by President Obama, and there are several more that have been proposed.
The superficial problem, such as there is one, is deciding on which replacement to use and which parts of each replacement.1
The real problem is that Republican have a strong tendency to pre-compromise. Even when they say that insurance works better and produces better medical care without the massive regulatory burden placed on it by the ACA, they still accept the premise: that they are talking about insurance. In fact, none of the people who have signed up on the exchanges or through ACA plans have insurance.2
If you can sign up after you get sick, that is not insurance.
Democrats will argue that this is being mean. This is untrue, and they know it, or they should. It’s simply the truth, it’s what insurance is: insurance is a means of insuring against some future calamity. If a calamity has already happened, it is impossible to insure against it. Anything that pretends to allow you to insure against a calamity that has already happened is not insurance, and cannot be insurance.
Anything that claims to insure past calamities is a scam. The ACA is a huge scam imposed by Democrats on the United States.
Our first Republican president once famously and apocryphally asked, “if you call a tail a leg, how many legs does a dog have?” He could as well have been talking about Obamacare. A tail is not a leg, and if you pretend it is you will experience massive failure.
Some Democrats will argue that ACA plans are health plans, and health plans are good. But they’ll quickly revert to saying Republicans want to take away people’s health insurance, because calling them health plans changes the narrative. It changes the negotiations and the nature of the compromises. There are, after all, other ways to deal with people who can’t afford health care than taking away everyone’s insurance.
This is an important distinction and a discussion the left doesn’t want to have. If you define ACA plans as insurance, you can pretend that the ACA, like Lincoln’s dog, has five legs, because everyone by law3 has ACA plans. But, as Lincoln noted, the ACA doesn’t magically become great at providing health care just because we pretend that a tail is a leg. The ACA does a very poor job of providing health care. The nature of the requirements the ACA makes on ACA plans and ACA providers ensures that deductibles are high, premiums are high, and health care providers are limited.4
As repeal moves forward5, you’ll see more and more news reports on people who will, according to the left and the news media, die because they will lose their insurance if the ACA goes away.
This is completely untrue, and they know it, or they should. And it isn’t just because the ACA is not insurance. The Republicans’ plans all include some means of providing public assistance for people who can’t afford the health care they need6, either because they don’t have the money or because they waited until they were already sick to buy insurance.7
Repealing the ACA will not take away anyone’s health care, nor will it take away anyone’s insurance. All it will change is that those who can’t afford their health care will get that care from public assistance that is called public assistance, rather than public assistance that is called insurance.
There is nothing wrong with having a program to assist people who can’t afford health care, and paying for it through an honest tax, preferably managed at the state level to improve accountability and responsiveness. Barring everyone from buying health insurance is not a good solution. It doesn’t even make sense as a solution.
What the left wants us to do is kill everybody’s insurance, kill everybody’s health care, kill all the innovation that will save lives for less money, so that people on public assistance can pretend that they’re not. What the left is asking us to do, in other words, is kill an infinite, uncounted, unknown number of people so that they can pretend their dog of a law can walk on its tail.
It can’t, and it never will.
In response to Why we must not ration health care: Rationing health care means fewer cures.
I have a strong suspicion that there is big money pushing a quick vote on replacement so that some kind of payoff can be hidden within it without scrutiny. And that the media is part of this attempt.↑
At least not through their ACA plans. Apparently there’s a growing market in insurance plans for people who forgo ACA plans and pay the tax penalty. But the ACA severely limits how these insurance plans work.↑
Everyone who is not exempted in some way, of course.↑
All of which were easily predicted by anyone who read Catastrophic Care: How American Health Care Killed My Father and realized that the ACA did little more than double down on all of the problems Goldhill writes about.↑
Assuming that it does move forward, which, given the way Republicans negotiate (or fail to) is not a given.↑
Some do it with block grants to the states, to pay for it through Medicaid or some other program; some even do it by requiring insurers to cover pre-existing conditions and then reimbursing the insurance companies for covering pre-existing conditions. There are a lot of ACA replacement ideas out there, and so there are probably even more means of handling people who can’t afford insurance in ones I haven’t read.
Note that I’m not saying they’re all good ideas. Handing it off to insurance companies is a very bad idea, not just because it adds another layer of bureaucracy but because insurance companies will quickly realize they can make more money by billing the government than by providing good insurance.↑
You want a great way to improve the number of people who have useful insurance? Make it easier for insurance providers to sell insurance against future health problems to people with pre-existing conditions, without forcing them to pay for the pre-existing conditions.↑