On Health Care: C’mon Democrats, Get in the Game

ryandumpNo need to write here about how terrible the Trump/Ryan GOP health care bill is; everyone else is doing a fine job of that. And not just from the left: look instead to Avik Roy, “the most influential conservative analyst of health care” according to talk radio’s Hugh Hewitt. Writing in Forbes last week, Roy called the bill a “a recipe for adverse selection death spirals” that is destined “to make health insurance unaffordable for millions of Americans, and trap millions more in poverty.” Sounds like a winner! And Monday’s much-awaited Congressional Budget Office scoring of the bill confirms it: for those with a precarious hold on being insured the so-called American Health Care Act is an approaching tsunami of health care misery.

Yet even a bill as intellectually dishonest and morally repugnant as this has some legs because in the wake of the great blue drubbing of 2016, the Democrats apparently haven’t yet learned about how to actually do opposition. Sure, they dutifully critique the bill when asked, but it’s feels as though they’re phoning it in, letting the bill divide Republicans and collapse of its own dead weight rather than going aggressively on the attack. And I fear the CBO report licenses Dems to stay passive. That’s a mistake because this isn’t just about beating back a terrible piece of legislation; it’s about setting the stage for 2018 by making sure Trump and Congressional Republican fully own every atrocious piece of it.

One way to do that is take a page from the Republicans, who understand the power of concise branding: wrap an issue in a memorable phrase (focus-group-tested by Frank Luntz, of course), and use it incessantly. “Death tax.” “Government takeover of healthcare.” In the present moment we find Republicans with one voice talking “access” over “insurance.” This one is especially sinister in its technical accuracy because there is always access – you might need money to buy it or a ride to the emergency room to wait for it, but in literal terms access to care can’t really disappear.

And so we get inanities like this this from Office of Budget and Management director Mick Mulvaney: “Insurance is not really the end goal here. We’re choosing instead to look at what we think is more important to ordinary people: can they afford to go to the doctor.”

Democrats can’t let Republicans get away with this because insurance is most certainly the end goal here. The notion of affordable access divorced from insurance is nonsense: unless your net worth is veering up into eight figures the simple inescapable reality is that you cannot afford health care. Oh sure you might be able to pay out-of-pocket for a doctor visit and maybe splurge on an xray or two. But actual routine insurance-relevant health care is unaffordable even for the affluent. Blow out your ACL playing ball one Saturday and you’re looking at $40K for surgery and rehab. Touch of appendicitis? Hope you’ve got $50K of room on your Visa card’s credit limit. Planning on taking out a second mortgage for that $100K hip replacement?

And don’t get me started on the non-routine. Okay get me started. A few years back I serendipitously discovered a little accident-of-birth “defect” in my noggin that left untreated had a 50-50 chance of doing me in. The total cost of the fix without insurance would have been in the neighborhood of $400K. Moral of the story: Unless you have the means to engage in $400,000 of discretionary impromptu spending, you cannot afford health care. But you can afford health insurance, and not having it, barring serious wealth (not mere affluence, but genuine, trust-fund level wealth), is seriously insane.

How many people have insurance and how many stand to lose insurance is most definitely not beside the point, as the Republicans wish us to believe; it’s exactly the point — one that Democrats need to jam into the throats of Republicans and hold there until they choke on it. Paul Ryan over the weekend made the absurdist argument that “the beautiful thing about this plan that we’re proposing, it is more freedom.” Democrats need make sure everyone knows that the “freedom” of which Ryan speaks is the freedom to be trapped without affordable insurance, the freedom to get sick and go broke and die in poverty. Now that’s some dynamite freedom!

Democrats may be smugly pleased with themselves as they try to force the label “Trumpcare” into the mix, but Trumpcare is way too charitable. We didn’t actually need Monday’s CBO scoring to tell us what everyone (including, yes, the White House) already knew — that the bill’s defining quality is the likelihood it will dump millions of people back into the ranks of the uninsured. So forget Trumpcare; how about #TrumpDump? It’s (marginally) catchy, it rhymes, it’s accurate, and it will annoy the Bloviator-in-Chief every time he hears it. Try using it in a sentence. Democrats should make it every sentence.

A version of this post appears at the Nashville Scene.


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