An Even More Better Way

Nobody likes the Republican plan. The nerds said it will screw everything up except for rich people. The übercons said it doesn’t harm enough poor people. The bleeding-heart moderates said it harms too many poor people. The liberals agreed with the bleeding-heart moderates, and they added that Jesus also would agree with them.

There’s been talk of some rework before it gets to the House, but with so much division it seems like any fixes will surely tip it too far for two-plus GOP senators. There’s no way they can swing single-payer. What to do?

  1. How to Pay for It
  2. Medicaid
  3. Marketplace
  4. Employer Coverage

How to Pay for It

Republicans hate taxes. That limits the options to some combination of:

  1. Raise the deficit.
  2. National lottery.
  3. Subsidized Time (see Infinite Jest by David Foster Wallace).
  4. Price controls.
  5. Competition.
  6. Carbon Tax.

Or some other things.

But healthcare costs. If you do what the current bill does, the cost of care still goes up when uncovered people need care and everybody else pays for it. We pay when people file for bankruptcy. We pay when people are sicker than they should be and call in sick.

Medicaid

Some people don’t make enough money to buy insurance. Either they can:

  1. Be sicker and raise the costs for everybody else
  2. Be subsidized
  3. Be given a raise such that they can afford insurance

Now, the current plan likes the first option. The ACA does the second. Maybe we should seriously consider the third, though. We could raise the minimum wage enough to ensure that everybody who works full-time can afford coverage. Something tells me the GOP won’t want to do that.

Marketplace (and Private Insurance)

For people who make enough money, healthcare is still very expensive, particularly if they become sick enough to run through their deductible. That’s at least $10,000 on average, per year of being sick. For upper-middle-class folks and above, it’s doable. For anybody lower down, more than a couple years of that will start to wear them down and make bankruptcy inevitable.

Ideally, for anybody who isn’t earning above maybe a couple times the poverty line, there would be a much lower cost guarantee, linked to income. Some sort of stability.

But none of this is entertained by the Republicans.

Employer Coverage

Employer coverage is a hardship for businesses and employees. It keeps people from changing jobs, and it makes it more difficult to start some businesses or grow them. It should be phased out.


The basic choice here ends up being between paying more, covering less, or cutting costs. All three are unpopular, but the current proposal sees kicking people off healthcare as the best choice of the three. It puts budgets and the wealthy before the people. So much for populism.