Rule by toddlers

If you’re the parent of a young child, you know the dollar store is a blessing and a curse. A blessing because you can always find something inexpensive to keep your little one from being booooorrrred for a while. A curse because the child learns to expect something from every time you drop in to buy garbage bags.

My five-year-old knows how to play this game, and he’ll inevitably ask to buy something whenever we stop in to Dollarama. But sometimes he won’t find something he really wants, so he’ll just grab something completely at random from a shelf.  It may be something in which he’s never before expressed an interest, or he may already have one gathering dust at home. Doesn’t matter: he had his heart set on getting a new toy, any toy is better than nothing, and the world will come to an end if you say no.

This is exactly what I thought of when the American Health Care Act, a cobbled-together replacement for Obamacare, just barely passed in the House of Representatives this afternoon:

The arguments on the floor—and the House’s decision to vote before the bill could be scored by the Congressional Budget Office—suggest that even many of the people who just passed it don’t even know everything about the bill. That’s to be expected: A collection of amendments written to garner political support since the original draft of the AHCA could have sometimes obscure interaction effects, and many of those are still being uncovered, even as the bill moves on to the Senate. But the broad strokes are known, and even with the official CBO report not expected until next week, health-policy experts have most of the AHCA figured out.


All in all, the baseline projections of reducing coverage by over 20 million people and federal savings of $300 billion will still apply to the AHCA, which must be officially scored by the CBO over the next few weeks in order to pass by the reconciliation process in the Senate. If passed there and signed by President Trump, the Medicaid program will be slashed, and fewer older, low-income, and sick people will be able to afford insurance. The Patient and State Stability Fund will likely provide financial relief and affordable coverage for thousands of sicker Americans, but it still appears that more people of similar health status will be ejected into the ranks of the uninsured. Fewer people will be offered employer coverage as well, although it’s unclear how much changes in essential benefits will affect them. The amendments will mostly affect those at the extremes. “In terms of their marginal effect, it all depends on what states will take them up,” Guyer said.

As the forthcoming CBO report will probably document, the basic framework of the law hasn’t changed that much. There are likely to be plenty additions to the AHCA as it goes through the more moderate Senate, and there will probably be tweaks that eliminate some of the current provisions in the House version. But as things stand, sick people and families that make less money will be less able to afford coverage than they are under the current law. Each change may necessitate a trip through the policy weeds to fully probe all of its effects, but the big picture doesn’t appear to be changing.

After years of moaning about Obamacare, Republicans were finally given the chance to do something about it, and were caught completely flat-footed.  But they had to do something for President Trump’s first hundred-odd days in office, so they threw together this disaster of a bill – which seems to accomplish little except rendering millions of Americans again uninsurable – so they could say they kept their promise.

In reality, the bill has almost no chance of making it through the Senate unscathed, but even if Trump and the GOP caucus hadn’t decided to throw a “Mission Accomplished” party in the White House Rose Garden this evening, they still would have come out of this looking callous at best and downright cruel at worst.

One of the things that drew me to conservatism is that it’s supposed to be prudent.  Conservatives are supposed to believe government should not embark on a major project – like, say, a fundamental restructuring of one-sixth of a country’s economy – without crunching the numbers, weighing the alternatives and making sure they get it right.

If the Republican Party hadn’t already exposed this as a myth by uniting behind a fundamentally unfit leader, the health care fiasco has ended all doubt.  And they will pay dearly in the 2018 mid-term elections, as long as Democrats don’t screw it up.

Aw dammit.

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