The possibility our government will shut down and default on our borrowings in order to kill the Affordable Care Act should bring the Yeats poem "The Second Coming" to mind. But I believe I have found a more relevant comparison: "Pepi Longsocks."
The skit was broadcast as part of the brilliant Canadian comedy show SCTV and was a dead-on parody of the Swedish "Pippi Longstocking" movies kids growing up in the 1970s watched on weekend television.
Pippi Longstocking was a child with superhuman strength softened by an almost cloying sweetness. Pepi Longsocks has the same strength, but winds up killing everyone around him because he can't control his temper.
"Now I have no one to anger me," the ironically anodyne, badly dubbed voice of Pepi (the late, great John Candy) declared after he smashed the last of his classmates and is left to half-heartedly skip around on his own.
Forty months after the ACA was passed into law and mostly codified by the courts, a group of people with great power but apparently lacking the temperament to control it, now want to put hundreds of government functions under tarps and possibly throw the nation into a fiscal crisis after we've just begun to emerge from one.
Many people who viscerally oppose the ACA--and President Obama by extension--have never considered the personal steel required to get him and healthcare reform where they are. I have little doubt the ACA will remain the law of the land no matter what else transpires.
So I try and look at the bright side: I could lose my house if business dries up because of a government default--but at least I won't lose it because of unpaid medical bills.
But I have to to look at the other side of this argument as well. Let's assume for a moment the ACA's opponents got their way and the law collapsed. What will they have achieved?
1. About 120 people will continue to die in this country every day because they lack health insurance and access to medical care that it provides. That's not the kind of stat to stake your public policy cred on, but most of those people didn't vote and are dead now anyway, so what's the difference?
2. The millions of middle-class people who purchase their own insurance won't get the hugely needed tax break that will lower their premiums. I had planned to use the estimated $300 a month I was going to save to invest in my IRA. And given the same people who want to dismantle the ACA will eventually set their sights on Social Security, I would say my family and I would be left in a bit of a pickle.
3. Millions of Floridians will be without a key consumer protection because its insurance commissioner--a political appointee who has held the job for more than a decade--was barred by legislative fiat from regulating premiums for new health insurance products for 2014 and 2015. That was intended to make policies sold on the exchange prohibitively expensive. It's not quite as despicable as lawmakers expressing their hatred of cars by barring seatbelts, but it's crowding the same territory. I would presume this legislative gem would survive even if the ACA did not. So expect even more people to be priced out of coverage as a result.
4. More hospitals will close because the expected billions of dollars of Medicaid revenue they were counting on would be gone. That was already happening in some of the states that refused to expand Medicaid eligibility. Expect a bunch more closures, which will no doubt help raise that 120-a-day national death rate.
5. If a default on our nation's credit is required before the ACA is killed, we'll likely have an actual depression to go along with it, because taking such a calamitous step in an economy as fragile as this one would be a likely tipping point. About 10 million people lost their insurance coverage during the Great Recession. Double that during Great Depression II. Double the rate of hospital closures as well. Those 120 deaths we now have a day will look positively rosy by comparison.
Indeed, there will be a lot of fallout as the people who killed the ACA skip around triumphantly to amuse themselves.
But at least we can breathe a sigh of relief. There will be nothing left to anger them ... Right? - Ron (@FierceHealth)
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