Justin Amash Is In Need Of An Ex-Lax

Nothing puts a smile on my face like killing my supporters!
Nothing puts a smile on my face like killing my supporters!

In an absurdly mendacious Facebook post, far-right ideologue and supposed Michigan Representative Justin Amash said, in effect, `y’all need to chill the fuck out!’:

The AHCA repeals fewer than 10 percent of the provisions in the Affordable Care Act. It is an amendment to the ACA that deliberately maintains Obamacare’s framework. It reformulates but keeps tax credits to subsidize premiums. Instead of an individual mandate to purchase insurance, it mandates a premium surcharge of 30 percent for one year following a lapse of coverage. And the bill continues to preserve coverage for dependents up to age 26 and people with pre-existing conditions.

I want to emphasize that last point. The bill does not change the ACA’s federal requirements on guaranteed issue (prohibition on policy denial), essential health benefits (minimum coverage), or community rating (prohibition on pricing based on health status). In short, Obamacare’s pre-existing conditions provisions are retained.

This is, (how should I put this?), ….

a bald-faced lie.

For all its faults, the Affordable Care Act cut the uninsured rate in half in this country, bent the cost curve down, saved at least 50,000 lives, and shaved at least half a trillion dollars off the 75-year debt projections.

What the new bill does change is significant. It ditches means-based and geographically-based subsidies altogether in favor of an age-based subsidy, so that Bill Gates would get a higher tax credit to purchase a plan on the exchange than I would. At least $600 Billion of the revenue that makes the ACA work is cut in the AHCA. The Medicaid expansions, about half of the ACA reduction in the uninsured, are phased out after 2020, affecting millions who will have little to no access to health insurance if this bill becomes law. That will cost tens of thousands of lives every year.

The changes in subsidies, the uncertainty of the non-statutory cost-sharing subsidies, and the phase-out of the Medicaid expansion will trigger a death spiral on the exchanges and for rural hospitals that will deny millions of Americans life-extending health care and cause immense quantities of needless suffering and death. At least 24 million of those insured on the exchanges and through Medicaid because of the ACA will lose coverage. The coverage losses from the exchanges are probably worth at least another ten thousand deaths a year. These losses will hurt Republican voters the most. Coverage loss maps show that the areas of greatest insured reductions are in some of the reddest places in America, like Nebraska, Kentucky, and Kansas.

Even for those who get health insurance through their employers or those of their family members, about 150 million, the bill has a serious problem. The states can petition this administration for exceptions to the mandated coverage provisions. They will get it. Then, there is a provision in the bill to allow large employers in any state to adopt the exemptions of the most backward state, so that employees of large companies can lose hospitalization coverage, or maternity coverage, or prescriptions, or whatever. I guarantee you will see at least some of this.

The idea that this bill makes no significant changes because somebody did a word count and found 90% commonality in the text is a childishly disingenuous dodge. It doesn’t take much textual change to cause suffering for millions.

And for what? To put some money in the pockets of a tiny handful of wealthy donors and to make a political point. Justin Amash is, how to put this delicately, ……

stunningly full of shit.

Blame the Framers

640px-Scene_at_the_Signing_of_the_Constitution_of_the_United_StatesOur Separation of Powers Presidential system is supposed to prevent any one person or small group from seizing control over American government. By constraining executive power with independent legislative and judicial branches that supposedly prevent abuses and excesses. Our federal system puts constraints on the power of the central government, reserving rights and powers to the States.

From the standpoint of the Eighteenth Century, the Separation of Powers system looked like it offered more benefits than problems. Disconnected from the rest of the world by one, and later two, oceans, the United States could afford to bumble and squabble. The only real threats were armed enemies, and nobody would prevent war against them.

The modern world is a different and faster place. Air travel, mass communications, modern weaponry, and a global economy have meant that problems move faster than our multiple veto points can move policy. Like many state systems, ours is designed for conventional interstate war, and that’s an obsolescent threat.

Not only can problems like climate change and gun violence fester and worsen while corporate lobbyists use our veto points to stop effective action, the lack of coherent policy breeds a dissociative type of politics where the bases of both parties see themselves as in opposition. The voters never get to see an ideology enacted, so festering ideological disputes are never resolved. As you can see in the contemporary conservative movement, the incentives are to become more and more extreme, using the language of oppressed minorities to ratchet the rhetoric more and more.

Now, even with one-party government, the State is paralyzed. We narrowly avoided a government shutdown over the weekend. Under conditions like these, it’s easy to see why every American-style government on Earth has collapsed into some kind of discontinuity, coup, crisis, or civil war. It’s also worth noting that, although our system was supposed to protect the people from excesses of government power, the United States has amassed a series of atrocities worthy of its status as a great power.