WASHINGTON – “The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.”
The novelist Anatole France’s mischievous observation came to mind when the Congressional Budget Office released its analysis of the Republican cut-taxes/gut-Medicaid bill and its defenders went into a continuous loop talking about “freedom.” Conservatives are fond of saying that freedom isn’t free. This is entirely true, especially when it comes to health care.
Republicans speak of the wondrous things that will happen if they succeed in slaying the monster known as “Obamacare.”
House Speaker Paul Ryan offered this rush of animated words to conservative radio host Hugh Hewitt: “You need to have an individual market where people care about what things cost, where people have real freedom, where those providers of health care services, be they insurers, doctors or hospitals and everybody in between, compete against each other for our business based on value, based on price, based on quality, based on outcome.”
Ryan spoke to Hewitt shortly before the CBO concluded that under his legislative contraption, 24 million fewer people would be insured over the next decade. Ryan dismissed the CBO in advance by accepting that the coverage numbers would, indeed, drop because people would be able to exercise a newfound right to be uninsured, much as they might be liberated to sleep under bridges or beg in the streets.
“We’re going to have a free market, and you buy what you want to buy,” Ryan explained. “They’re going to say not nearly as many people are going to do that.”
Left-wingers are often cast as dreamy utopians, but it’s Ryan and his allies who pretend they can create a capitalist paradise in health care – something that not one wealthy capitalist country has ever done because the health care market is not like any other.
Older people, for example, are not an ideal market for private insurance companies. That’s why we have Medicare. Lower-income people can’t afford to pay the full cost of a decent insurance policy. That’s why we have Medicaid, and why the Affordable Care Act subsidizes policies from private insurance companies.
Slash Medicaid and take away the subsidies and, presto, the ranks of the uninsured mushroom. There is thus something unseemly about Ryan declaring that he is “so excited” about eviscerating Medicaid. “We are de-federalizing an entitlement, block-granting it back to the states, and capping its growth rate,” he told Hewitt. “That’s never been done before.”
Of course, maybe it’s “never been done before” because enough politicians stood up to resist the cruel idea of tossing so many people overboard.
Defenders of this proposal try to argue that health “care” is radically different from “coverage.” They must think the American people are dunderheads.
“Coverage is not the end,” Mick Mulvaney, the director of the Office of Management and Budget, said on MSNBC’s “Morning Joe” Tuesday. “People don’t get better with coverage. They get better with care.”
Well, sure, but try taking your kids to get care from a pediatrician if you don’t have insurance coverage. Or do backers of the Coverage Destruction Act of 2017 just want people to get sicker and sicker until they have to get really expensive care in an emergency room – which may come too late?
Ryan urges people to read his bill. If you do, you’ll realize how many of its pages are devoted not to health care but to tax cuts. According to the CBO, the bill takes $1.2 trillion out of helping people get health care (including $880 billion from Medicaid) and then hands out about $600 billion of that in tax cuts, mostly for the well-to-do and various interest groups, the beleaguered tanning industry being my favorite. This could also be called the Make Inequality Worse Act of 2017.
In his youth, Ryan was a devotee of Ayn Rand, whose philosophy is nicely summarized by the title of her book “The Virtue of Selfishness.” She would be proud of her one-time disciple. She excoriated “the draining, exploitation and destruction of those who are able to pay the costs of maintaining a civilized society, in favor of those who are unable or unwilling to pay the cost of maintaining their own existence.”
In other words, government should never take money from the better-off to help lesser souls. In the glorious future created by Ryan’s bill, they will now be even freer to try “maintaining their own existence” without health insurance.
E.J. Dionne’s email address is email@example.com. Follow him on Twitter @EJDionne.