CNN, put on ice by the Trump administration, is looking to alternate sources for its infotainment, and so will host Tuesday evening a town-hall debate between Bernie Sanders and Ted Cruz on the future of the Affordable Care Act.
I’m not sure what bearing this has on anything, but it might be entertaining. They can both get a good head of steam going once they’re worked up. Because Bernie’s not much of a numbers man, it wouldn’t surprise me to see Cruz win on wonk points, except of course for the fact that most of Cruz’s numbers will come from the Congressional Budget Office of Klingon.
If Sanders manages to drive home one point, I hope it is this: that the Republicans know that there is no way in the world that they can replace Obama without spending about as much money as Obamacare. Or, they can do it, but they’ll be throwing millions of people off coverage.
It’s a confusing time and it’s hard to keep up, because new crazy comes out of the White House every day, or more than every day. Donald Trump holds our attention because he’s Trump and he’s the president and he can blow up the world.
But it’s important that we not forget the normal Republican crazy, because it’s crazy too, and it’s mean and it’s dishonest and it only looks less so by comparison to the president. And the normal Republican Obamacare position is crazy.
Consider this one policy detail, which speaks volumes. Speaker Paul Ryan and Congressman Tom Price, the man likely to become the new HHS secretary this week despite the fact that he traded in health care stocks whose value was affected by legislation he was working on, have both said that after dismantling the hated Obamacare, they would take care of people with preexisting conditions by placing them in so-called high-risk pools.
This is a bad idea that is at odds with the very idea of insurance, but set that aside for now. Price, in his legislation on the matter, proposed spending $1 billion a year on these pools (see Section 201 of this). Ryan would more generously put $2.5 billion a year toward these pools (the document uses the figure $25 billion, but the context suggests that Ryan means that over 10 years, which is how budget wonks often talk).
Now, here’s your question. In the real world, we have many experts who have studied the question of what these high-risk pools would cost in one year. Remember, these are the people who are the very most expensive to insure and treat in the country; the sickest among us. Depending on what you count and include, there are between 12 and 19 million of them.
You think maybe it’s $15 billion? $20 billion? $30 billion?
A recent Commonwealth Fund study says the number is closer to $178 billion. Now, I will note that this isn’t exactly an apples-to-apples comparison, because the Commonwealth paper includes certain costs that Ryan and Price put in a different category (for example, Ryan’s alternative to the ACA’s Medicaid expansion). So the real difference isn’t quite this staggering. But let me put it this way. The 2008 campaign of John McCain—a Republican, of course—estimated the cost of a national high-risk pool at more than $100 million a year.
The Republicans know, and have known from the beginning, that the magic they promise on health care can’t possibly work. They know that if they repeal Obamacare and “replace” it with something designed not to try to meet people’s actual needs but just look like they did something and hope the country doesn’t notice, they’ll have a political nightmare on their hands. And a sicker country, though there’s no evidence they actually care about that.
In any case the people are onto them. Google “Obamacare protests” today and you won’t find stories about Tea Partiers screaming about the march of socialism. You’ll find instead story after story describing how Obamacare beneficiaries and defenders are showing up at Republican House members’ town-hall meetings to demand that their representatives refuse to cast a reckless vote to replace an imperfect something with a pixie-dust handful of nothing.
So here is the vertiginous situation in which we find ourselves. On the one hand, we are terrified of Trump, because he’s an unbalanced man with access to the nuclear football and the ability to deploy the agencies of the executive branch in whatever Nixonian manner occurs to him. Since he appears to have no moral core, he is capable of anything.
But on the other hand, Trump may be the backstop against congressional Republican excess. They want to repeal the New Deal. Trump probably doesn’t want to do that. And he probably doesn’t want to throw 12 to 19 million people off of their insurance plans, or suddenly hand them $30,000 each in out-of-pocket expenses, not because it’s bad for them but because it will most assuredly be bad for Trump. So if he’s at 40 percent and Reince Priebus shows him polls telling him that what Ryan wants to do to Obamacare will put him at 34, he may actually, however briefly, be sanity’s ally.
That, sadly, is where we are. We’re sitting at a blackjack table with Nero (Ryan, or shall I say Ryan-McConnell) and Caligula (Trump). Sometimes we’ll want Nero to draw the four of hearts and stand on 20, and sometimes we’ll want him to bust so Caligula can win one. On health care, we’re pulling for Caligula for now.
And as for Bernie: It’s his job Tuesday to expose the Ryan “plan” for the snow job that it is. Chuck Schumer has given Bernie a lot of power in the Senate Democratic caucus, considering that Sanders still refuses to become a Democrat. Tonight’s a good time for him to show he can make a case for the team and not just for Bernie.