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Death and Tax Cuts

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image Constituents listening to Senator Bill Cassidy on Tuesday at a town hall meeting in Denham Springs, La. Credit Emily Kask for The New York Times

...It was basically a sick joke: flat tax credits, unrelated to income, that could be applied to the purchase of insurance....

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the 20 million Americans who gained health insurance thanks to the Affordable Care Act, and will lose it if the act is repealed.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, Representative 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, Mr. 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 Mr. 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.

For 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, I’m sorry to say, because they are deeply committed to Americans’ right to buy the insurance policy of their choice.

No, mainly they hate Obamacare for two reasons: 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!

Read my blog, The Conscience of a Liberal, and follow me on Twitter, @PaulKrugman.



Paul Krugman

Macroeconomics, trade, health care, social policy and politics.

 

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