Senator Bill Cassidy, Republican of Louisiana, is the co-captain, with Susan Collins from Maine, of his party’s last remaining lifeboat away from the listing hulk of the TrumpCare legislation that currently is stuck in the doldrums of the legislative process. Cassidy is a physician, so the proposal he co-sponsors has that going for it. The difference between the C-C plan and the fiasco currently stuck in the mud in Congress is that C-C doesn’t entirely blow up the Affordable Care Act.
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Instead, C-C doubles down on that dubious notion of Leaving It Up To The States. Under C-C—and, yes, any amendment to it will be called a C-C Rider around this shebeen—the states will have three options: to keep the ACA as is; to switch to a different health insurance expansion that would automatically enroll the uninsured into a new federal catastrophic insurance plan; or to opt out of the business of healthcare entirely, which also would mean giving up the FREE MONEY (!) currently available under the ACA’s Medicaid expansion. This plan is considered to be a “moderate” middle solution because, at least in some states, it leaves the ACA theoretically intact.
The most obvious problem is that many of our states, particularly the poorer ones—like Cassidy’s Louisiana—recently have been run, or currently are being run, by morons. These are the people who, for specifically boneheaded ideological reasons, refused even the FREE MONEY (! ) that was made available to them in 2009. Even though Louisiana now has a Democratic governor who took the FREE MONEY (!) almost immediately after being inaugurated, there’s no guarantee that the next governor there won’t be an ambitious wingnut like “Bobby” Jindal, so some of the folks who showed up at Cassidy’s town hall in Covington on Wednesday remained dubious concerning Cassidy’s proposed “compromise.”
Many of these people were asking the quite logical question concerning the basic philosophy on which both the C-C plan, and the dead fish American Health Care Act, are based: Namely, what is the principle behind a state-based healthcare plan? Or, put more simply, what is it about the people in Louisiana that makes their basic healthcare needs essentially different from those of the people in California or Massachusetts? Simply arguing against “one size fits all,” or “top-down management” isn’t going to cut it much longer, and Paul Ryan’s incantations about “patient-centered” healthcare reforms are as empty as all of his other promises are.
Again, our experience with the FREE MONEY (!) is helpful here. States were free to choose to accept it or not. The ones that did saw better outcomes among their poorer residents. There is no difference between a person with cancer in Mississippi and a person with cancer in Minnesota except that the state of Mississippi has determined that the person with cancer there will have a harder road because, basically, that person is on their own.
Sooner or later, the country is going to have to take a good hard look at what’s happened in Kansas for the thoroughgoing disaster that it is. On that day, the whole political notion of leaving everything “to the states” will die a long-deserved death. In truth, as bogged down and unresponsive as the federal government is, on many issues, especially this one, state governments are infinitely worse. Their politicians are more easily and more cheaply purchased and their politics are more vulnerable to the whims of weaponized yahooism.
Some problems, and more than many politicians are willing to admit, demand national solutions, no matter what your local Babbitt-o-crats have to say about it. This is one of them.