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Health Care and ‘The Virtue of Selfishness’

E.J. DIONNE JR. on

WASHINGTON -- “The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.”

The novelist Anatole France’s mischievous observation came to mind when the Congressional Budget Office released its analysis of the Republican cut-taxes/gut-Medicaid bill and its defenders went into a continuous loop talking about “freedom.” Conservatives are fond of saying that freedom isn’t free. This is entirely true, especially when it comes to health care.

Republicans speak of the wondrous things that will happen if they succeed in slaying the monster known as “Obamacare.”

House Speaker Paul Ryan offered this rush of animated words to conservative radio host Hugh Hewitt: “You need to have an individual market where people care about what things cost, where people have real freedom, where those providers of health care services, be they insurers, doctors or hospitals and everybody in between, compete against each other for our business based on value, based on price, based on quality, based on outcome.”

Ryan spoke to Hewitt shortly before the CBO concluded that under his legislative contraption, 24 million fewer people would be insured over the next decade. Ryan dismissed the CBO in advance by accepting that the coverage numbers would, indeed, drop because people would be able to exercise a newfound right to be uninsured, much as they might be liberated to sleep under bridges or beg in the streets.

“We’re going to have a free market, and you buy what you want to buy,” Ryan explained. “They’re going to say not nearly as many people are going to do that.”

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Left-wingers are often cast as dreamy utopians, but it’s Ryan and his allies who pretend they can create a capitalist paradise in health care -- something that not one wealthy capitalist country has ever done because the health care market is not like any other.

Older people, for example, are not an ideal market for private insurance companies. That’s why we have Medicare. Lower-income people can’t afford to pay the full cost of a decent insurance policy. That’s why we have Medicaid, and why the Affordable Care Act subsidizes policies from private insurance companies.

Slash Medicaid and take away the subsidies and, presto, the ranks of the uninsured mushroom. There is thus something unseemly about Ryan declaring that he is “so excited” about eviscerating Medicaid. “We are de-federalizing an entitlement, block-granting it back to the states, and capping its growth rate,” he told Hewitt. “That’s never been done before.”

Of course, maybe it’s “never been done before” because enough politicians stood up to resist the cruel idea of tossing so many people overboard.

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