The Choices We Make

It's hard to believe that the most incredible statement out of Washington this week didn't come in the torrent of offensive and misogynistic tweets fired off by the Embarrassment in Chief. While Donald Trump was busy further demeaning the Office of the President in a flame war over something trivial, the Republican Speaker of the House, Paul Ryan, put forth an incredible assertion around the most important legislative debate in the country.

When asked about the estimated 22 million people who would become uninsured under the AHCA Senate bill, Ryan told Fox News the following, "What they're basically saying at the Congressional Budget Office is, if you're not going to force people to buy Obamacare, if you're not going to force people to buy something they don't want, then they won't buy it. So it's not that people are getting pushed off a plan. It's that people will choose not to buy something they don't like or want."

At face value Ryan is saying that there's no forced takeaway of healthcare under the AHCA, rather people will choose not to have coverage without the Obamacare mandate. There is likely some truth to that statement as there's certainly a percentage of stupid in the country that will choose not buy health insurance even if it is within their means. However, it's unfathomable to assert that the majority of the 22 million potentially impacted by the AHCA would choose not to buy insurance if it were affordable. The reality is that many would "choose" not to buy healthcare because the AHCA pushes premiums out of the range of affordability much in the same way a poor single mom may "choose" to skip a meal for her kids because the family cannot afford it. That's hardly a choice, and therein lies the lie Speaker Ryan is peddling.

In reality the AHCA force millions to make the "choice" between health insurance and food, rent, and other necessities. That point alone clearly doesn't trouble GOP lawmakers who cannot take their eye off the ball when it comes to tax cuts for the wealthy which is the other impact the AHCA is designed to deliver. GOP megadonor Sheldon Adelson's tax bill will drop by $40 million alone if the AHCA becomes law.

The economic impact of the AHCA is even bigger than just the toll on individuals. Let's look at the state of Texas which is no stranger to giving the middle finger to common sense. Under Obamacare, healthcare enrollment did increase thanks to the individual mandate, however, Texas "chose" not to expand Medicaid leaving many in the insurance gap, one of the problems areas that needs to be addressed with the current Affordable Care Act, if congress and the GOP in particular were actually serious about improving coverage. Furthermore, private hospitals in wealthy Texas counties "chose" not to take patients that were uninsured leaving people no alternative but to swamp emergency rooms of public hospitals in urban areas such as Parkland Memorial which has seen a 72% increase of out of county poor patients over the last five years. Parkland lost $6 million last year alone and the out of county patient increase has cost $27.4 million since 2012. The burden is unsustainable and threatens the entire community should a resource like Parkland fail.

The "choice" Republicans are offering on healthcare is no choice at all. The intent of their healthcare fix is strictly to fix what they believe to be unnecessary spend on people that don't matter - aka the poor - and put that money back into their own pockets where they believe it rightfully belongs - the rich. The working middle class that will also be hurt along the way are apparently acceptable casualties toward this end.

The real choice in the healthcare debate isn't one where the American people choose between buying coverage or not. The choice is whether GOP leaders act to deliver affordable healthcare to all Americans or act to deliver a tax cut to the top one percent.

Paul Ryan knows that. Hopefully, enough of his constituents do too.