Wednesday, July 19, 2017

Where we go from here on healthcare

After McConnell's repeal-and-replace plan failed, and then he hilariously tried to sell that dead parrot of a "repeal-and-delay" stunt (which collapsed within hours after Collins, Murkowski and Capito told him to go fuck himself), where do we go from here?  There are two paths.

1)  Fix the law
Yes, Obamacare is screwed up.  As written, there was nothing in place for what happens when every insurer pulls out of a market, for example, and we have a bunch of counties with nobody selling insurance, combined with a mandate to buy insurance.  That's... not good.  There are other problems too, but that one is the biggest.  The "risk corridors" are also a problem.  Those would be the policies intended to transfer money to the insurers who, through bad luck, happen to get sicker pools of customers.  There are plenty of problems in the law.  Since the Republicans are not going to repeal it, the statutory problems kind of should be addressed.  The problem is that this needs to be bipartisan because of... the Freedom Caucus.  This can't be done by the Republicans alone because the Freedom Caucus and others will oppose any fix.  In the Senate, Rand Paul and the rest of the drama club will oppose any fix.  In fact, most of the GOP will oppose "fixing" Obamacare because it will mean "collaborating."  They have spent so much time decrying Obamacare as an apocalyptic nightmare that they have made this option almost unthinkable.  In the Senate, Collins, Murkowski, Capito, Heller, sure.  They can go along with this, as long as McConnnell lets it happen, but McConnell tried to revive "repeal-and-delay."  Will he really go along with it?  That brings us to...

2)  Sabotage
There are actually three GOP options for sabotage.  First, do nothing.  The holes in the existing law are a problem.  How big will they grow?  We don't know.  The "Obamacare is in a death spiral" line is almost certainly bullshit, but there are real problems, some of which are growing.  Each time another county sees its last insurer pull out, the problems get bigger.  Second, at the state level, governors and state legislatures have plenty of sabotage options.  They control state exchanges, after all.  However, the most dangerous is Trump himself, and he has made noises indicating a desire to engage in administrative sabotage.  He has the option to do something extraordinarily dangerous.  Those risk corridors?  He can basically cut off payments to insurers at the federal level because of a stupid mistake in how the law was written (a sort of a typo, which is actually the subject of a lawsuit).  If he shuts down guarantees to insurers, or tells the IRS to stop enforcing the individual mandate, or something like that, we start to see an absolute disaster.

The real danger, then, is Trump.  He likes to say that sabotage will force Democrats to give him concessions.  No.  It won't.  He's just incredibly fucking stupid and vindictive.  If he engages in sabotage, here's what happens:  the healthcare system tanks, and in the next election, the president takes the blame.  He is already historically unpopular.  Gallup's daily tracking has him at 39% right now.  That's not going up, and people attribute credit or blame to the president for national conditions.  Midterms go against the party of the president anyway, except under extraordinary circumstances.  Yes, Trump was unpopular during 2016.  How did he win?  The Democrats had won the two previous elections, and James Comey decided he didn't want Clinton in office.  Neither of those will save his party in 2018, particularly if he decides to sabotage the healthcare system.

Does that mean he'll do the sane thing?  I wouldn't bet on it.  Trump is stupid and vindictive.  He just lost, "bigly."  He needs to enact vengeance, and rationality has never been his strong suit.

The only thing that would save him from that midterm disaster if he sabotages the healthcare system?  A war.  I'm not joking about this.  We are entering extremely dangerous territory now.  Here is a serious possibility to consider:  Trump may lash out by sabotaging the healthcare system, and then start a war to try to salvage public opinion.  How likely is this?  I have no idea.  This is about trying to predict Trump-- a psychopathic idiot child.  But, even Mitch McConnell has been driven so crazy that he tried to revive "repeal-and-delay."  Rationality is out the window here.  I have no idea what's going to happen, and that's scary.

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