Death and tax cuts

Northwest Arkansas Democrat-Gazette - - VOICES - Paul Krug­man Paul Krug­man, who won the 2008 No­bel Prize in eco­nomics, writes for the New York Times.

Across the coun­try, Repub­li­cans have been fac­ing crowds de­mand­ing to know how they will pro­tect the 20 mil­lion Amer­i­cans who gained health in­sur­ance thanks to the Af­ford­able Care Act and will lose it if the act is re­pealed. And af­ter all that in­veigh­ing against the evils of Oba­macare, it turns out that they’ve got noth­ing.

In­stead, they’re talk­ing about freedom—which these days is the real refuge of scoundrels.

Ac­tu­ally, many prom­i­nent Repub­li­cans haven’t even got­ten to the point of try­ing to re­spond to crit­i­cism; they’re just whin­ing about how mean their con­stituents are be­ing and in­vok­ing con­spir­acy the­o­ries. Talk about snowflakes who can dish it out but can’t take it!

Thus, Rep. Ja­son Chaf­fetz in­sisted that the public out­cry is just “a paid at­tempt to bully and in­tim­i­date”; Sean Spicer, the White House press sec­re­tary, calls all anti-Trump demon­stra­tions a “very paid, AstroTurf- type move­ment.” And the tweeter in chief an­grily de­clared that protests have been “planned out by lib­eral ac­tivists”—be­cause what could be worse than po­lit­i­cal ac­tion by the po­lit­i­cally ac­tive?

But per­haps the sad­dest spec­ta­cle is that of Paul Ryan, the speaker of the House, whom the me­dia have for years por­trayed as a se­ri­ous, hon­est con­ser­va­tive, a deep thinker about how to re­form Amer­ica’s safety net. That rep­u­ta­tion was never jus­ti­fied; still, even those of us who long ago rec­og­nized him as a flim­flam­mer have been struck by his ut­ter fail­ure to rise to this oc­ca­sion.

Af­ter years to pre­pare, Ryan fi­nally un­veiled what was sup­pos­edly the out­line of a health care plan. It was ba­si­cally a sick joke: flat tax cred­its, un­re­lated to in­come, that could be ap­plied to the pur­chase of in­sur­ance.

These cred­its would be ob­vi­ously in­ad­e­quate for the lower- and even mid­dle-in­come fam­i­lies that gained cov­er­age un­der Oba­macare, so it would cause a huge surge in the num­ber of unin­sured. Mean­while the af­flu­ent would re­ceive a nice wind­fall. Funny how that seems to hap­pen in ev­ery plan Ryan pro­poses.

That was last week. This week, per­haps re­al­iz­ing how flat his ef­fort fell, he be­gan tweet­ing about freedom, which he de­fined as “the abil­ity to buy what you want to fit what you need.” Give me con­sumer sovereignty or give me death! And Oba­macare, he de­clared, is bad be­cause it de­prives Amer­i­cans of that freedom by do­ing things like es­tab­lish­ing min­i­mum stan­dards for in­sur­ance poli­cies.

I very much doubt that this is go­ing to fly now that or­di­nary Amer­i­cans are start­ing to re­al­ize just how dev­as­tat­ing loss of cov­er­age would be. But for the record, let me re­mind ev­ery­one what we’ve been say­ing for years: Any plan that makes es­sen­tial care avail­able to ev­ery­one has to in­volve some re­stric­tion of choice.

Sup­pose you want to make in­sur­ance avail­able to peo­ple with pre-ex­ist­ing con­di­tions. You can’t just for­bid in­sur­ance com­pa­nies to dis­crim­i­nate based on med­i­cal his­tory; if you do that, healthy peo­ple won’t sign up un­til they get sick. So you have to man­date the pur­chase of in­sur­ance, and you have to pro­vide sub­si­dies to lower-in­come fam­i­lies so that they can af­ford the poli­cies. The end re­sult of this logic is . . . Oba­macare.

And one more thing: In­sur­ance poli­cies must meet a min­i­mum stan­dard. Oth­er­wise, healthy peo­ple will buy cheap poli­cies with pa­per-thin cov­er­age and huge de­ductibles, which is ba­si­cally the same as not buy­ing in­sur­ance at all.

So yes, Oba­macare some­what re­stricts choice—not be­cause meddling bu­reau­crats want to run your life, but be­cause some re­stric­tions are nec­es­sary as part of a pack­age that in many ways sets Amer­i­cans free.

Health re­form has been a hugely lib­er­at­ing ex­pe­ri­ence for mil­lions. It means that work­ers don’t have to fear that quit­ting a job with a large com­pany will mean loss of health cov­er­age and that en­trepreneurs don’t have to fear strik­ing out on their own. It means that those 20 mil­lion peo­ple who gained cov­er­age don’t have to fear fi­nan­cial ruin if they get sick, or un­nec­es­sary death if they can’t af­ford treat­ment. For there is no real ques­tion that Oba­macare is sav­ing tens of thou­sands of lives ev­ery year.

So why do Repub­li­cans hate Oba­macare so much? It’s not be­cause they have bet­ter ideas; as we’ve seen over the past few weeks, they’re com­ing up empty-handed on the “re­place” part of “re­peal and re­place.” It’s not be­cause they are deeply com­mit­ted to Amer­i­cans’ right to buy the in­sur­ance pol­icy of their choice.

No, mainly they hate Oba­macare be­cause it demon­strates that the gov­ern­ment can make peo­ple’s lives bet­ter, and it’s paid for in large part with taxes on the wealthy. Their over­rid­ing goal is to make those taxes go away. And if get­ting those taxes cut means that quite a few peo­ple end up dy­ing, re­mem­ber: freedom!

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