If "A" then "B", and "A". Therefore "B". And, if not "A" then not "B". Not "B". Therefore, not "A". Those are two rules of logic known as Modus Ponens and Modus Tollens respectively. What they mean is that if you know that two things always go together, if one of them occurs then both of them will. Conversely, if you know that one of them definitely will not occur, then the other definitely won't either. That basic logic is relevant today, in the period just prior to the assumption of complete control of our government by the Republican Party, because there are some things that are as they are by necessity because of other things that they have insisted on and the lack of some things that they have prevented. The Affordable Care Act...Obamacare...is a perfect example.
Obamacare was a web of supplemental provisions that all worked together, albeit imperfectly, because all of them existed. When you remove one of them, Modus Tollens begins to have an effect. For example, the consensus view is that the success of the program depends on near universal coverage. But some people still can't afford health insurance, so they don't sign up with any company. And then there are the young and healthy who think nothing can happen to them. They don't sign up either, but in the final analysis, the entire ensured population is a single symbiotic organism. Each of us depends on the others' premium contributions just as all the others depend on each of ours. So, there have to be inducements to participate, such as subsidies for the poor and avoidance of a tax for those who opt not to participate for their own reasons, be they affordability or just perceived lack of need. If you take away those inducements, other provisions, and in fact the whole program, begin to fail. The Affordable Care Act is a living tissue that, when wounded, shrivels and dies. So, now comes Donald Trump and the conservative Republican Party. They don't like this and they don't like that. They don't like government control of anything, which they characterize the ACA as being. And if you're Donald Trump, you don't even need a reason to call it "a disaster," which is Trump's way of saying, "I don't like it so it has to go." Thus, they have set out to...and Trump has promised that they would...repeal Obamacare, and as an afterthought, replace it. But lately Trump says that some parts of the program have to stay: the bar to denial of coverage because of prior conditions and the maintenance of insureds' children until they reach 26. But those things have to be paid for, and that is why the ACA included several taxes and fee adjustments paid to insurance companies and hospitals. They fund the program, and without them, taxes have to go up...either taxes or the national debt and the yearly budget deficit. So, what's a body...a conservative body...to do. Damned if they know. What they do know is that they don't want a program created by any damned Democrat, so it has to go. Here's the rub...or several of them.
First, there are 20 million people on insurance they got through the ACA. You can't just cast them out into the cold. Second, if you keep the provisions that everyone likes--and there are more than just the two I mentioned, but few people talk about them--how do you pay for them, especially when you have promised to cut taxes too. Then, what about the people who are benefiting from expanded Medicaid. There are millions of them too, and that was part of the ACA too. Trump's suggestion that you substitute HSA's or Health Savings Accounts makes no sense in light of the problem that the ACA addresses. It's like the old joke: "If I could walk that way, I wouldn't need the talcum powder." People who can't afford health insurance can't put money away to pay for health care either. They will need subsidies, so what's the advantage over Obamacare. And the fact of all these problems, which militate against the creation of other problems, is what has kept the Republicans from coming up with an alternative to the ACA thus far, so again, what's a conservative body to do.
Well, the answer is no longer the problem of us progressives. We wanted at least a "public option" in the ACA if not a single payer system for everyone, like Medicare. That's what all of the other thirty most industrialized, modern nations in the world have, that or an Obamacare type system, and there's a reason for that. It saves money in the long run and augments our economy. It doesn't diminish prosperity; it enhances prosperity...for everyone. So Paul Ryan, Mitch McConnell, Donald Trump, this is what I have to say to you. You weren't careful what you wished for...and now you've got it.
Your friend
Mike
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