The first reports said the Republican dream of repealing Obamacare was dead. Now it turns out that, after heroic measures, it’s on a ventilator in the intensive care unit with no sign of brain activity. Ironically, thanks to the Affordable Care Act itself, Medicare will cover the “death panel” end of life counseling that will hopefully allow the Republicans to let their loved one go.
Meanwhile, the progenitor of the GOP dream — the entire right-wing ideology that justified the obsession with Obamacare in the first place — is also quite ill. That ideology is so freakish, and so violently violates human nature, that it’s hard to believe the conservatives who believe in it have ever actually met a person.
So let’s take a look at this philosophy’s different components so we can use this moment to murder it most efficiently.
“Freedom,” House Speaker Paul Ryan explained in February as he rolled out his ACA replacement, “is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.”
The problem here is that no one anywhere has any idea what their “needs” are when it comes to healthcare. When Hamlet soliloquized about the “thousand natural shocks that flesh is heir to,” it was a huge understatement. With bodies that can be afflicted by anything from anaplasmosis to zoonotic hookworms, it’s incredible any of us are alive.
For instance, one morning in January 2009 my father went outside to bring in empty trash cans, slipped on some ice, and fell and bruised his spinal cord. He lay there in the driveway for five minutes, unable to move anything below his neck, until my mother came out and found him.
Until that moment he had no idea he would need four operations, 45 days in a rehabilitation hospital, and a pump implanted in his abdomen with a thin tube threaded up his spinal column to drip muscle relaxant into his spinal fluid at his c3 vertebrae.
Medicare was the greatest imaginable blessing during all of this. It paid the enormous cost of almost all of my father’s treatment, so he could concentrate on regaining the ability to walk without worrying whether his one misstep would force him and my mother to sell their house to pay for it.
My family experienced this as pure, precious freedom. But to Paul Ryan, we were wrong about that, and actually were being crushed under the boot of tyranny. To be truly free, Ryan would say, my parents required the opportunity before my father’s accident to run millions of Monte Carlo simulations of the future to calculate whether it was financially rational to buy insurance that covered these extremely unlikely needs. Instead Washington forced them to purchase Medicare’s damnable one-size-fits-all coverage.
That, of course, is totally crazy. Which is why no major political party in any industrialized country looks at healthcare like this. Instead they accept that people do not possess precognition, and hence the only way health insurance can work is if it simply pays for whatever happens to everybody.
Another premise of Ryan’s theory, he said, is that “we don’t really have a consumer dynamic in health care” because patients don’t have “skin in the game.” That is, patients don’t know how much medical treatments cost — so we need high deductibles to give them the incentive to bargain with their doctors and drive down costs.
As someone who has literal skin in the game, I can tell you this is similarly insane. Four years ago this week I was diagnosed with melanoma, the rarest form of skin cancer and the most likely to kill you.
I wasn’t particularly concerned when I went to see a dermatologist — in fact, I was so unworried that I only did so because I had fantastic insurance with no deductible and no copay. The doctor took five minutes to scrape it off, leaving me (KNOCK ON WOOD) cancer-free.
To me, this was the best possible outcome. From Ryan’s perspective, it was a disaster. In the healthcare system he wants, I would have looked at the peculiar mole on my leg, and then at the balance in my health savings account, and calculated that it wasn’t worth spending my own money to get it checked out. After months went by and it slowly expanded, I would have researched which physician would send my tissue sample to cheapest possible pathology lab.
By then, of course, it might have metastasized, and I would have ended up costing the medical system hundreds of thousands of dollars. More significantly to me, I might currently be dead.
So what Ryan somehow doesn’t understand is that healthcare isn’t a consumer good that people enjoy purchasing. We want to buy a 65 inch TV or a Lexus ES 350. No one wants to buy a colonoscopy. So there’s no need to dissuade people from getting preventative care; we dissuade ourselves. And if we decide not to go on vacation in Des Moines, there’s no chance that down the road we’re going to need to go skiing in the Alps or die.
Moreover, no patient anywhere has ever wanted to establish a “consumer dynamic” with their doctor. You know the saleswoman at Best Buy doesn’t have your best interest at heart; you would like to believe that your neurosurgeon actually does and is not trying to upsell you on an expensive new brain operation.
But as ludicrous as Ryan’s perspective is, he at least rhetorically accepts that society has some responsibility to provide healthcare to everyone. The hard-right Freedom Caucus killed Ryan’s bill because they honestly don’t.
The more benign interpretation of the Freedom Caucus view is that they do want everyone to have healthcare but genuinely believe that if you simply get the government out of the way, markets will somehow provide it for everyone. The fact that this has never happened anywhere at any point in history does not faze them. Rep. Jim Jordan, R-Ohio, the former co-chair of the Freedom Caucus, was recently asked, “Is there a state or a country with the kind of health care system you’re talking about that we should be trying to emulate here?” His response: “I’ve not seen that.”
However, those who hold this ideology do sometimes come straight out and acknowledge that they believe that people with serious health problems and no insurance should simply die. Most famously, the audience boisterously cheered this idea at a 2011 CNN/Tea Party Express presidential debate.
The good news is that the GOP’s healthcare debacle shows that this is palatable to an extremely small number of Americans. Most of us can accept that some people can’t buy a 5,000 square foot house or own four cars. But when they’re face to face with it, almost everyone recoils from a system in which those without enough money can’t afford life.
So it’s never been fair to say Republicans lack a thought out, coherent philosophy behind their healthcare policies. They do have one. It’s just nonsensical and barbaric. We shouldn’t miss this opportunity to throttle it and inter it in history’s Graveyard of Terrible Ideas.