No, Seriously. We Have to Work Together.

The Republicans made a good show of trying to fix it all themselves, only to find out that they couldn’t agree. That’s fine. They should learn their lesson and we should all learn it. We can’t do it by ourselves.

Whether it’s finding a new balance on welfare and minimum wage, where we don’t want to subsidize Walmart workers, but we don’t want to push people out of work and onto welfare, or whether it’s on regulation where we want to be sure that we’re not poisoning our air and water, not destroying habitats, but we don’t want businesses to spend a ton of money just on paperwork, we have to come together.

That means we have to keep going back to first principles. What is the system there for, and if it’s there for the wrong thing, we need to change it to target our actual goals. And that’s hard, because it requires a level of honesty from politicians they’re not accustomed to. They can’t just hide behind calling the system a mess or sad, but have to say what they actually think it’s for.

On climate change, it’s harder as the Republicans hold somewhere between “it’s not happening” and “it’s not humans doing it.” On proposed actions, we see claims about killing jobs and high costs. For that reason, working together likely first requires establishing the baseline beliefs about jobs.

Jobs are there to do useful work. If the wages can’t be high enough to do needed work, the government subsidizes that job. Otherwise, the work isn’t important enough. Or, work for work’s own sake is good, and we should subsidize any work, no matter how useless. Or some middle ground.

Same on illegal immigration. Underpaid labor. Should the price of produce rise and we send those folks home, hoping their economies of origin grow to support them? Should we legalize them? Certainly the decision should not be made strictly on the basis of existing law. It should be what’s best. But that requires, again, someone like Trump to admit what their core goal is. Is it racism, or is it giving Americans those jobs, or just what is it?

But the alternative is basically to continue down the current path, which is a dumb beast of government that thrashes and turns randomly, wrapped in its own bindings, trying to see its way forward.

Why Don’t Republicans Want the Last Word on Healthcare?

The Democrats took their crack at major reform with the ACA, and since January the Republicans have been seeking to answer it (after their long chants of “Repeal and replace”). But the answers they have produced so far cannot and will not be the final say on the matter. They have to know that. The question is why?

The simplest answer is that they cannot come together on a reply. Their coalition is too broad and divided to give the answer that would be coherent, so they are stuck with simply saying “No” to the Democrats. Rather than admitting that the country needs universal coverage and figuring out how to spread the cost across the concerns, they are stuck simply reducing what the Democrats did.

Those concerns:

  1. Providers’ profits
  2. Taxes of the rich
  3. Taxes of the non-rich
  4. Coverage for the vulnerable (elderly, poor, disabled, etc.)
  5. Insurers’ profits

The Democrats spoke with the ACA, saying: “We will limit insurer profits, increase some taxes on the wealthy, and provide coverage for the vulnerable.” It was a cohesive statement.

But the Republicans are currently saying something like: “We will increase insurers profits, reduce some taxes on the wealthy, and reduce coverage for the vulnerable.” They’re just gainsaying. This is not an argument. It’s mere contradiction. Someone call up Monty Python.

The Republicans have to know that Democrats, next time, will not just repeat their previous statement when they enact healthcare reform. They will probably say, instead: “We will grandfather existing plans, but everybody else goes to a single-payer system paid for by taxes and with costs controlled by negotiating with providers.”

What will the Republicans say to that? “Socialized medicine?” When people will still pay at least part of their premiums, a la Medicare? When the CBO will say that it increases coverage and decreases costs?

This is the Republicans’ best shot at answering the Democrats, but their answer is weak. They may pass it anyway, but it will not be the last word, and they know it.

When an Experiment is Unneeded

The Republican-championed laboratories of democracy, the states, could be used to figure out what’s needed for healthcare in the 21st century. Let the states tinker, find out what works, and then we’ll see it spread.

But those experiments are not needed. We have scores of experiments conducted all over the world. We have all these examples of healthy healthcare in all these other countries. We just don’t have the political will to enact the sensible and sane in the USA.

Now, in Europe each state has its own healthcare system, and the US might still divide a universal system into per-state systems. But the Europeans also have the EHIC system, which allows for dependable treatment when traveling (both unplanned care and for chronic treatment).

The US might still do things different than Europe and the 58 countries with universal care. But the idea that we can’t figure out a problem that 58 other countries have? The amount of denial required to reach that conclusion could only be described as gross negligence.

We don’t need to experiment with allowing states to ignore real insurance in favor of slimmed-down plans that will result in financial burdens on the infirm. We don’t need new work requirements that undermine the definition of universal. We might make some minor use of high-risk pools, but we know the basic shapes that universal coverage come in.

It is high time that any party that seeks national recognition in the US would have a plan for universal coverage. That is a low bar for 2018. The Democrats currently seek a single-payer medicare-for-all style system. If the Republicans do not answer with a 50-states-plus-DC alternative, it will only be a matter of time before CMS is charged with overseeing healthcare across this nation.

We don’t need an experiment. The time where an AHCA or a BCRA might have reflected something the US would do is gone. The cardboard reads “Universal Healthcare or Bust!”

Trade the Rich Their Taxes for Healthcare

Given the amount of control the wealthy have over the state and federal governments, this might be the best market-driven solution to healthcare. The basic outline is that the rich will pay less in taxes (limited to the portion paying for health-related services) as healthcare costs decrease and coverage levels increase. Since they care enough about taxes to make the Republican Party try to pass these bloodthirsty bills (AHCA and BCRA), we should let the rich take control over their own tax destiny.

Now, it’s a little more complicated than described, because there are more rich people in blue states that already make a bigger effort to increase coverage and decrease costs than many red states do. So the mechanism can’t be “if you live in a state that does better, you pay less tax.” That would also not work due to venue shopping, where the rich would just establish residency in states where they would pay less federal tax (some may already do this, if they can deduct state tax from federal and federal from state; but that depends on whether they can control which state their income comes from).

But the basic outline is there. And it could very well be bipartisan if the lever moves both ways. That is, if failure to diminish costs and increase coverage means they pay more tax, the Democrats might be able to deal with a bit of deregulation and help pass it.

Other sticking points would be that there would have to be a fairly rigid definition of coverage (something the Republicans seek to undo with their evil pair of bills), and there would have to be other broad strokes about existing conditions and bans on lifetime and annual maxima. But if the rich hate paying tax that much, they should be drooling at the chance.

Given we pay much more per capita and we don’t even have universal coverage, there should be a lot of cost savings available that the rich can tap to reduce their tax burden. They can buy all the hospitals and streamline them. They can focus on prevention and interventions for patients with high-cost conditions. They can buy the pharmaceutical companies and slash back the price hikes we’ve seen in recent years. Invest heavily in automation.

But one way or another, this country needs affordable care for everybody. If the rich want to get lower taxes in the bargain, I suggest that Congress lets them pull all of us up by their bootstraps.

We Never Win in Healthcare

The Republicans in Congress are not sending their best bills. They’re sending the pharmaceutical companies—drug dealers—a chunk, the rich get their check, but ordinary Americans? We get screwed again. So little winning, you’re going to get so sick from not winning. Believe me.

We spend more money, and we get less. That’s not winning. That’s getting played. And it’s got to stop. We have to win again on healthcare. We have to pay less money and everyone has to be covered. From the sick poor kid that wants to grow up to be a baseball player to the old lady that used to do radio jingles—back when people still listened to the radio. They all need healthcare.

And cutting red tape is not going to do it. It will save a bunch of corporations money, which they will pocket. We know this because that’s what they have done, time and time again. They pad their portfolios while the rest of the country breaks its back, and it doesn’t get the back treatment it deserves. They don’t pay for infrastructure. They don’t pay to make sure you can even get to the hospital safely if you have to cross a bridge. Pitiful, folks. This is a mess.

The Republicans want to say this isn’t the role of government, that it’s not in the Constitution, but show me where in there it says that old people should suffer, or that a sick kid that can’t afford treatment should have to go beg for her life on a crowd funding site. Tell me where it says that in the Constitution.

And they say that states need more flexibility in Medicaid. Like these precious snowflakes of state governance can’t operate a simple program that says that poor people get healthcare? Please! If they can’t figure it out, we shouldn’t repeal and replace the program, we should repeal and replace them.

Every other country figured this out. They’re eating our medicine, folks. They pay more in taxes, but less overall because they get higher wages and lower costs. That’s winning. If you ask me, the Republicans have turned taxes into a whip to keep people in line. Some late-night bogeyman story to scare people. But the greatest generation paid higher taxes! And they were so tough, they liked it!

These Republicans have gone soft. Sad! We need to win on healthcare again, and if the Republicans won’t let us win, they should at least have the good God damned sense to get out of our way.