President Donald Trump shaking hands with Speaker of the House Paul Ryan at his February 28, 2017 address to a joint session of Congress.
Donald Trump, who was elected in part because he promised cheaper, better healthcare for more people, shakes hands with Paul Ryan, whose answer to Obamacare is markedly worse for so many people. Public domain photo released by the Office of the Speaker, courtesy of Wikimedia Commons.

Last month when the GOP got their first honest-to-God chance to repeal the Affordable Care Act (which they nicknamed “Obamacare”), their failure to follow through despite having majorities in both houses of Congress and a Republican president merely illuminated what most of us have suspected all along, which is that their years of bluster have been a steaming pile of politics and that there’s rather little in the way of actual governing going on. The GOP healthcare zombie seems once again to be poking its withered fingers out of the legislative grave, though, this time with a new “conservative” solution to the problem of expensive premiums: high risk pools.

Let’s back up a bit. The concepts built into “Obamacare” were once the free market conservative answer to the Dems’ reform plan of single payer coverage for all. An early version of the ACA could once have been legitimately called Nixoncare. However, in a polarized political environment like we’ve been cultivating for decades, Republicans could ill afford to look like they were cooperating with a compromise-minded centrist Democrat. They dropped their once-cherished, Heritage Foundation-approved ideals as quickly as Larry Craig dropped his drawers in an airport bathroom and commenced to throw more shade at them than could ever be cast by a “90 story” Manhattan tower.

So what does this have to do with the high risk pools in the Healthcare Plan of the Living Dead? Simple. The GOP and their base have a basic disconnect when it comes to the insurance people want. The problem Republican voters had with the ACA, like a lot of people, is that health insurance is expensive the way we do it in America. If you earn too little to afford it easily, but too much to qualify for (underfunded) subsidies, you’re in a really tough spot. Donald Trump capitalized on this real economic pain by promising better coverage for more people at cheaper prices (hey, whatever it takes to get elected!) but soon learned that this was pretty impossible to accomplish here in the real world. Meanwhile, the House Republicans were trying to figure out how to produce a product that could still technically be called “insurance” which was also cheap enough to satisfy both kinds of voters: their wealthy donor-friends who want to pay less in taxes, and the folks hurting back home who can’t afford the premiums. High risk pools are one way of doing that.

If you saw Paul Ryan’s headshaker of a Powerpoint presentation last month, you caught him utterly failing to understand what insurance is all about. “The fatal conceit of Obamacare,” he explained, was that younger and healthier people pay into the system more than they take out, subsidizing the older and sicker people whose medical bills would be too expensive to handle on their own. That’s the way all insurance works, though: by pooling risk. We all invest in the system so it will (hopefully) take care of us if the worst happens, but thankfully, most of us won’t need it. Meanwhile, the people that really do need it (hopefully) won’t be bankrupted by an unfortunate accident or diagnosis.

In Paul Ryan’s world, though, the only thing that the luckier people got from the system was the bill. If those people were moved into low risk pools and the older, less healthy people into high risk pools, then people likely to use less medical care got a great deal, and in the brutal, All-American tradition of leaving behind those who need help the most, those in the high risk pools could fend for themselves with more expensive premiums. The fact that a lot of Republican voters would find themselves in more expensive, high risk pools, though, might not play well in Peoria, especially since they voted the Red Wave into Washington in part because they couldn’t afford what they were already paying. So the GOP solution is – get this – subsidies, paid by taxpayers, to benefit those in high risk pools.

Insurance companies would prefer not to cover old and sick people who are more likely to cost them money.  Remember, this is why the government stepped in to cover our elders when nobody else would: that’s how we originally got Medicare, which the GOP now wants to privatize again.

Let’s review: Obamacare subsidies are “bad.” Younger, healthier people subsidizing older, sicker people is “bad.” Everyone subsidizing older, sicker people, though, that’s the new, conservative answer! Man, you can lead them to the high risk pools, but you can’t make them think.

Fact is, no matter how we reform health care, there will be winners and losers. If anyone tells you differently, they’re trying to sell you a steaming pile of …politics. We need to have an honest, grown-up discussion about health care in this country. If we could address the health care problem like a country that cared about its people and their outcomes at least as much as it cared about money, imagine what we could do with all that energy.

Why Can’t America Have a Grown-Up Healthcare Conversation? Posted by vlogbrothers

Related: Cheaper Healthcare: Waste Not, Want Less


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