by Max Brantley
By Ernest Dumas
Ignorance may not exactly be bliss, President Trump and a lot of other politicians are discovering, but it is a good operating model as long as wisdom doesn't rear its ugly head.
But in the case of Obamacare and the Patient Protection and Affordable Care Act, wisdom, or a tiny cache of it, is what has befallen the president suddenly, and it has created a dilemma for the party with which he shares governance.
Through the campaign and afterward, Trump described Obamacare (never "the Affordable Care Act") as a "total disaster" and he promised to replace it with a system that covered every American with better benefits and at costs far lower than people now pay for their insurance. His exact words: "We're going to have insurance for everybody. There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us. People can expect to have great health care . . . much less expensive and much better."
If he had the barest knowledge of what the law did, he would have known his promise was mathematically impossible, unless he had in mind some form of universal socialized medicine like Great Britain's, Israel's, or Cuba's, and also a political absurdity.
Someone sat him down in late February and explained to him how Obamacare worked and why dismayed congressional Republicans in seven years had never produced the miraculous replacement he had described.
"Nobody knew health care could be so complicated," Trump mused.
But House Republicans unveiled their plan Monday and hoped to rush it through committees by week's end. It doesn't come close to meeting the president's description, but he will pretend that it does and will bet that the voters will be as ignorant of "Obamacare Lite," as conservatives are calling the GOP plan, as they (and he) were of the original.
Insurance will be far more expensive for millions of people, millions more relatively poor people will lose insurance altogether because the premiums will be far out of reach, others will have their benefits and coverage reduced, not expanded as Trump promised. And it will be repeal in name only. Like Obamacare, the plan is built upon government subsidies, in the form of income tax credits, to help people buy private health insurance policies, but the tax credits will be useless for people with low family wages because premiums and deductibles will be out of reach. People from 50 to 65 (Trump votes?) will see their premiums and deductibles soar so that people in their 20s can see theirs go down.
But Obamacare Lite will achieve the two things the big opponents of the law have sought most since 2010: It will end Obamacare's taxes on rich folks like the Koch brothers and the benefiting medical businesses, which pay for the program, and sharply reduce government aid for poor people to gain access to medical care.
In Arkansas, perhaps the single biggest beneficiary of Obamacare because it insured 400,000 of the state's neediest people and bailed out the state treasury and budget, the state government is moving in tandem with Washington's economic royalists by setting rules that deprive the poorest of health care if they can't hold a steady job. The governor rejoiced last week that 25,000 poor people had been stricken from the rolls and that many more would follow.
Congressional Republicans are experiencing a reprise of 2010, when people aroused by industry and party ads claiming this new law, "Obamacare," was going to strip away their Medicare, take medical decisions away from them and their doctors and assign it to the government, cut life support for grandma when she got sick and turn America into a socialist state. The new president was unpopular enough in the South and rural middle America and they assigned his name to this complicated system for expanding the right of medical care to everyone. Obama said he was happy to be its namesake, and that's what it became.
It had two big flaws, both pointed out by the insurance industry: The government's fundable tax credits were still too small to make private insurance affordable to many lower-income households and the tax penalty for people who didn't buy it was too low to induce healthy young people to buy it, which forced the companies to raise premiums. Red-state governors and legislatures threw up roadblocks, refusing in 19 states to cover the poorest people under Medicaid after the Supreme Court gave them the option and erecting other barriers to people buying the insurance. The Arkansas legislature blocked the use of $10 million of federal aid to help people enroll.
Slowly, ignorance subsided and now most Americans think Obamacare is a good deal and, like Social Security and Medicare, just needs some fixing.
They're already venting their doubts about Trumpcare, or Ryancare, or whatever distasteful epithet sticks to the ramshackle new health law, if indeed it passes. Republicans pray they remain at least partially ignorant until, say, after the 2018 election.