We are about an hour and a half from the House vote on the ludicrously named American Health Care Act, which brings to mind the famous phrase from Joseph Conrad’s Heart of Darkness: “The horror! The horror!” In typical fashion, Not-My-President Trump is threatening recalcitrant Republicans in the House that he will “come after you” if they don’t support the AHCA. Changes are being made to make the legislation more palatable to extreme right-wing Congressmen in the so-called Freedom Caucus. It’s hard to tell what is going on because most of the action is behind closed doors, but it seems clear that major reductions in benefits for low-income people have been incorporated into the legislation to buy votes of the ultra-conservative far right wing of the Republican Party. Those Republicans coldly and calmly stand before media cameras and boast about removing health care benefits from the AHCA package.

Given the inhumane indifference with which the AHCA treats most health-challenged people and given that it includes a large tax break for the wealthiest Americans, there is nothing good to say about the legislation. Most Democrats have railed against it since its details were released after much secret negotiating among its Republican sponsors.

What has begun to stand out to me is that while Democrats have rightly and righteously opposed the AHCA, they, including former President Obama himself, have acknowledged that there are issues with the Affordable Care Act (aka Obamacare) that need to be addressed. Instead of producing an alternative to the AHCA that would make repairs where needed, however, the Democratic leadership has focused entirely on the multitude of negative features of the “repeal and replace” legislation.

This may be a political attempt to make the Republicans “own” the AHCA and its inevitably horrific consequences, but it strikes me, late in the game (I admit), that this is not the best strategy. Rather than simply counting on a handful of Republican legislators to block the legislation in the House or Senate, it would have been better, I think, to offer a realistic alternative to the current Obamacare.

Perhaps most interesting are the observations of Jennifer Rubin, described by the Washington Post as a person who “writes the Right Turn blog for The Post, offering reported opinion from a conservative perspective. She covers a range of domestic and foreign policy issues and provides insight into the conservative movement and the Republican Party.” http://wapo.st/2nSfAyQ. Rubin said this:

“… the legislation is a dog’s breakfast. It’s a bill that does not repeal Obamacare and does not address the most acute issue, namely rising premiums. Speaker Paul Ryan (R-Wis.) keeps promising that will be addressed in the third prong of legislation, but as Sen. Tom Cotton (R-Ark.) points out that is never happening (since there are not eight Democratic votes). If the GOP passes this, it will be stuck with the worst of all worlds — a highly regulated insurance market with skimpier tax credits than were available under Obamacare. That, plus the roll back on Medicaid expansion, explains why so many conservatives and moderates oppose it.

The bill was so unworkable Ryan had to come up with a last minute “manager’s amendment” to, for example, try to improve support for rural, older voters who are badly hurt. But there is no legislative language laying that out. Those who vote for this literally won’t know what is in the bill. In short, it’s bad legislation that will hurt people, many of whom voted for President Trump. If it passes, the problems with the bill and the hard luck cases will be on the heads of Republicans.

As for the politics, it has already split the party and pitted Republicans against one another. It gets a pitiful level of support. Voters, as opposed to politicians and political insiders, rank health care relatively low on their priority list. Voters really are not clamoring for this. Rather than get mired down in an endless negotiation back and forth with the Senate and be responsible for a lousy outcome, Republicans would be wise to move on to jobs, just as the president said he wanted to do.”

Further:

“Obamacare’s faults don’t make the case for this particular bill. Significant numbers of Freedom Caucus members are saying the bill does not do what it is supposed to. Perhaps they have internalized the real lesson of Obamacare: Don’t pass a bad bill, take responsibility for people’s health care and hope it gets fixed later. Right now, Sen. Cruz won’t vote for the bill. And he’s right. It should die in the House.”

http://wapo.st/2nnIh93.

It is not the case that some of the fixes to Obamacare have not been identified. For example, Nalini Pande, Sappho Health Strategies, LLC’s Managing Director, who has significant health care policy credentials and experience, has identified three “repairs” worth consideration:

“(1) Increasing subsidies for the poor so that the Exchange plans are more affordable; (2) Encouraging state insurance commissioners to conduct stronger rate reviews/rate regulation to prevent unreasonably high rate increases … and … to ensure that for-profit insurers are not increasing rates at a dramatically high rate to ensure more profits for shareholders at the expense of their customers – this goes for employer plans, not just plans on the Exchange under ACA; (3) stronger evaluations on plan performance, premium increases and surplus and reserves, especially for-profit insurers/health plans.”

As I stated in my previous post, I claim no expertise in health care or insurance policy, but Pande’s prescriptions make sense. There are likely many others. Hopefully for the country, the Democratic strategy will work out in the end and the AHCA will be defeated. If not, the failure to offer an effective alternative may be seen as a very serious error.