On Friday, Ezra Klein reminded us, The Anti-Obamacare Movement Is Making Red States Sicker and Poorer. I understand what the Republican elites tell themselves. By doing the maximum amount of damage to the law, it will become untenable. People will not sit by and watch the health insurance industry in Arizona be destroyed. They will demand action. But given that over half of the people in the United States will be doing just fine, I don’t see people rising up and saying, “Let’s get rid of Obamacare!” I see them saying, “Let’s get rid of these jerks running the red states who don’t care at all about their people!”
Of course, this is in reference specifically to King v Burwell. But the truth of the matter is that it applies to everything. The refusal to accept the Medicaid expansion in 22 states only hurts those states. It not only deprives many of their working poor of health insurance, it deprives the states themselves of billions of dollars in economic stimulus. This is all, once again, in the name of symbolism: they won’t accept any help from that communist in the White House. But it does those states no good. All that such symbolic measures do is allow the politicians to fight with each other for the mantle of Most Conservative. And when they all qualify for the award, none of them get any benefit from it.
The other side of this is that these red states are still bound by the healthcare law. They still pay taxes for it. They just aren’t getting all of the benefits — and if King v Burwell is upheld, they won’t be getting any benefits. Ezra Klein is exactly right when he summarized the situation, “In effect, the Republican plan to destroy Obamacare has become a plan in which red states subsidize Obamacare in blue states.” Very effective, guys!
According to estimates of the Kaiser Family Foundation that were quoted by Klein, the Republican petulance regarding Obamacare has resulted in five million extra people going without health insurance and foregoing a staggering $37 billion every year. That’s roughly the total GDP of Wyoming. So Republicans are causing enormous amounts of pain to themselves for a very low probability of getting rid of the hated healthcare law.
And let’s remember, Obamacare is about as conservative an approach as there is to healthcare reform. The one part of it that Republicans most complain about — the individual mandate — was the basis of the very conservative Heritage Foundation plan. Now it is true that the Democrats added — Oh, the horror! — subsidies to help middle and lower class workers. But the truth is that the plan never would have worked without these subsidies. This, above all, is why the Republicans have been unable to come up with something to replace the law with: Obamacare is the conservative replacement. This has gone along with conservative healthcare “wonks” looking all over the world to find a conservative plan that works. And they always end up embarrassing themselves, because the other plans always turn out to be more liberal than Obamacare.
It’s all just a mess. And I am absolutely certain that in ten years, all the states will have fully embraced Obamacare. Republicans will even run against Democrats claiming that they want to make workers pay more for healthcare. But in the meantime, huge amounts of suffering will have gone on — both directly in terms of fewer people being covered and indirectly by harming the economy. But by then, it will all be forgotten. American politics really isn’t ideological anymore. The question that workers have to answer is simply, “Which party will govern with even the most basic competence?” And the answer is the Democrats. The Republicans don’t even try.