28 June 2017 — 1418 mdt
Keep the heat on Daines — here’s how and why
Mitch McConnell has delayed a vote on gutting Medicaid. He hasn’t given up, and won’t. He just needs a bit more time to find the price of 50 votes for his bill.
Meanwhile, as Sen. Steve Daines prepares for a “telephone town hall” this evening, the Billings Gazette reports that McConnell’s bill would cost Montana $5.3 billion, and cause the state to “struggle to pay for education, infrastructure.”
Opponents of the bill should not give up, either.
Keep the heat on Daines, directly through calls, letters, and the usual means, and indirectly, through contacts with hospital trustees and executives and other conservative community leaders. Groups such as Big Sky Rising should also consider calling Daine’s donors in Montana and asking them to ask him to oppose the bill. The donor list is available at the Federal Elections Commission.
Can the Ryan and McConnell bill be stopped? On that question, I’m a pessimist, but not a fatalist. There’s not a state in the union that supports the bills. Normally, that would be enough to kill both bills. But these are not normal times. The Republican caucus is gripped by a dangerous group psychosis. The impetus for the bills is the reactionary ideology of Congressional Republicans who, as David Brooks observed yesterday, don’t give a damn about the consequences of their legislation on the country as a whole:
Because Republicans have no national vision, they seem largely uninterested in the actual effects their legislation would have on the country at large. This Senate bill would be completely unworkable because anybody with half a brain would get insurance only when they got sick.
Worse, this bill takes all of the devastating trends afflicting the middle and working classes — all the instability, all the struggle and pain — and it makes them worse. As the C.B.O. indicated, the Senate plan would throw 22 million people off the insurance rolls. It would send them to private insurance plans that they could not afford to buy. Under the Senate bill, deductibles for poor families would be more than half of their annual income. The plans are so incompetently and cruelly designed that as the C.B.O. put it, “few low-income people would purchase any plan.”
This is not a conservative vision of American society. It’s a vision rendered cruel by its obliviousness…
For a more incisive analysis of the ideological underpinnings of Trump-Ryan-McConnell Care, Brooks might have turned to Jacob Hacker’s 2006 book, The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream. Writing in 2006, Hacker first explained the concept of social insurance:
The breakthrough of 1935 was momentous all the same, for Social Security embodied a bold new imperative of government action: insurance. The word rings familiar today, but it once had a radical air. Insurance was an affirmation of free will over fate. If not an effort to stay the hand of God, it was an attempt to soften his blow. And it rested on modern statistics and actuarial science — which which were being employed with increasing sophistication by America’s growing network of insurance companies in the 1930s. Witte, in fact, packed the technical working group that was developing oping the Economic Security Act with private insurance experts willing to deploy the intelligence of insurance on behalf of the nation’s economic future.
The intelligence of insurance became genius when insurance principles were coupled with the power of the state to require participation ticipation and ensure adequate and affordable coverage. “Social insurance,” as it was called, transformed individual misfortunes into common problems. It made the inevitable dislocations of capitalist society risks that could be managed and redistributed, rather than blows of fate that could only be feared and suffered. The “insurance” in social insurance came from the power of aggregation: Risks that could devastate an individual or community could be managed if they were spread across many individuals and many communities. The “social” in social insurance came from the principle of shared fate, the reassurance that “we’re all in this together.” All insurance pools risks. Only social insurance pools risks on terms that enable the poor as well as the rich, the aged as well as the young, the ill as well as the healthy to afford protection. The crafters of the Economic Security Act believed that insurance had to be available able and within the means of those who needed insurance most. [Highlighting added by Flathead Memo.]
At the heart of this belief was a simple conviction: broadly distributed threats to economic well-being-sickness, injury, disability, unemployment, penurious old age-were not the responsibility of individuals alone. They were a widespread and often unavoidable able feature of an interdependent industrial society. And because they were, the cost of these risks should be distributed widely across the citizenry, not concentrated on those unlucky enough to experience them — a goal made possible by the unique power of government to compel participation and require contributions. Government could pool the risks of millions of citizens. It could guarantee that even workers of limited means were able to afford basic protection. tion. And it could require that everyone contributed to this common mon pool throughout their lives, rather than waiting until they fell on hard times or disaster struck, when — for all but the richest — it would be too late.
Next, he described the philosophy encoded in Trump-Ryan-McConnell:
“Designed properly,” in the new efficiency critique of insurance, had two meanings, both of which struck at the heart of the argument ment for broad-based social insurance. “Designed properly” meant, first, that insurers had to charge subscribers in close accordance with their expected probability of requiring help, something private insurers only halfheartedly did, and government insurance virtually never did. Because they were known risks, people who had preexisting conditions, such as a heart murmur or diabetes, would be asked to pay more or even be denied health insurance. People at greater risk of disability would need to pay more for disability ability insurance. Otherwise, by this line of logic, insurance would unfairly subsidize high-risk groups, increasing costs for the healthy and prudent, and for society as a whole.
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Of course, this critique-that insurance didn’t charge premiums in close accordance with expected risk or aggressively monitor policyholders’ behavior was directly at odds with the conception of insurance that had emerged out of the New Deal. Social insurance (even when under “private auspices,” as the proponents of Blue Cross health plans described their mission) was supposed to provide subsidized coverage to high-risk groups and those who couldn’t easily purchase commercial policies. Social insurance was supposed to protect beneficiaries from the intrusive and stigmatizing interventions ventions into private conduct that had been so characteristic of assistance policies in the past.
But, according to the new science of moral hazard, these convictions were destined for history’s dustbin. The appropriate standard, this perspective insisted, was not whether insurance created broad risk pools or provided economic security. It was efficiency, and to the critics, social insurance was anything but efficient. [Highlighting added by Flathead Memo.]
It is the very idea of social insurance, of pooled risk, of “because we’re all in this together, we should work togethetr to help each other” that Trump-Ryan-McConnell rejects. They should rename their bills the “You’re on Your Own Acts of 2017.”
In a radio address to the nation on the third anniversary of the Social Security Act of 1935, President Franklin Roosevelt said:
The millions of today want, and have a right to, the same security their forefathers sought — the assurance that with health and the willingness to work they will find a place for themselves in the social and economic system of the time.
Because it has become increasingly difficult for individuals to build their own security single-handed, Government must now step in and help them lay the foundation stones, just as Government in the past has helped lay the foundation of business and industry. We must face the fact that in this country we have a rich man’s security and a poor man’s security and that the Government owes equal obligations to both. National security is not a half and half manner: it is all or none.
The Social Security Act offers to all our citizens a workable and working method of meeting urgent present needs and of forestalling future need. It utilizes the familiar machinery of our Federal-State government to promote the common welfare and the economic stability of the Nation.