Paul Krugman: Obamacare vs. the GOP zombies

COVID-19 cases are surging in states that took Donald Trump’s advice and reopened for business too soon. This new surge — is it OK now to call it a second wave? — is, on average, hitting people younger than the initial surge in the Northeast did. Perhaps as a result, rising infections haven’t been reflected in a comparable rise in deaths, although that may be only a matter of time.

There is, however, growing evidence that even those who survive COVID-19 can suffer long-term adverse effects: scarred lungs, damaged hearts and perhaps neurological disorders.

And if the Trump administration gets its way, there may be another source of long-term damage: permanent inability to get health insurance.

Remarkably, last week the administration reaffirmed its support for a lawsuit seeking to overturn the Affordable Care Act, which would, among other things, eliminate protection for Americans with preexisting medical conditions. If the suit were to succeed, having had COVID-19 would surely be one of the preexisting conditions making health insurance hard, perhaps impossible, to get.

Now, the legal argument behind the case is beyond flimsy: The lawsuit claims that the 2017 tax cut effectively invalidated the act, even though that was no part of Congress’ intention. But with a conservative majority on the Supreme Court, nobody knows what will happen. And Trump’s support for the suit makes it clear that if reelected he will do all he can to destroy Obamacare.

Not to worry, says the president. In tweets over the weekend he insisted that he would come up with an alternative to Obamacare that would be “FAR BETTER AND MUCH LESS EXPENSIVE” while protecting Americans with preexisting conditions.

But he’s been claiming to have a much better alternative to Obamacare since he took office. Republicans in Congress, who voted to repeal Obamacare 70 times during the Obama years, have been making the same claim for more than a decade.

Yet somehow the great alternative to the Affordable Care Act has never materialized. In 2017, when the GOP finally came close to repealing the act — failing thanks only to a last-minute change of heart on the part of Sen. John McCain — the plan on offer would have stripped away protection for preexisting conditions and added 23 million Americans to the ranks of the uninsured.

In other words, Republicans’ insistence that they have a superior alternative to Obamacare is a zombie lie — a claim that should be dead after having been proved false again and again, but it is still shambling along, eating people’s brains.

But why can’t Republicans come up with a better alternative to Obamacare? Are they just incompetent? Possibly — but even if they did know what they were doing, they couldn’t produce a superior plan, because no such plan is possible. In particular, unless you’re willing to move left instead of right, by going for single payer, the only way to guarantee coverage for Americans with preexisting conditions is a system that looks a lot like Obamacare.

The logic here has been clear from the beginning. To ensure coverage of people with preexisting conditions, you have to prohibit insurers from discriminating based on medical history. But that’s not enough: To provide a decent risk pool, you also have to induce healthy people to sign up, preferably with both subsidies and a penalty for being uninsured. In other words, you need a system that is basically Obamacare.

The 2017 tax cut, which did away with the individual mandate — the penalty for noninsurance — weakened the system; you can see this by the fact that states, like New Jersey, that imposed their own mandates saw a drop in insurance premiums. But the design of the subsidies, which insulated most people from rising premiums, contained the damage: The percentage of Americans without health insurance, which fell sharply as a result of Obamacare, remains near record lows.

So is there any alternative to Obamacare? Of course there is. We could go back to being a country in which people with preexisting conditions and/or low incomes can’t get health insurance, where for a large fraction of the population illness either goes untreated or leads to bankruptcy. That would, in part, mean becoming a country in which Americans who caught COVID-19 during the pandemic would be uninsurable for the rest of their lives.

Indeed, turning us back into that kind of country is the GOP’s true goal, and is what will happen if the party gets its way either as a result of the current lawsuit or through legislation during a second Trump term.

But Republicans can’t admit that this is their goal. The public overwhelmingly supports protection for Americans with preexisting conditions, so right-wing politicians have to pretend they can provide that while dismantling the regulations and subsidies such protection requires. And they have to hope that voters won’t remember that they have been promising a plan, but never delivering, for more than a decade.

Let’s hope voters are smarter than that. Fool me once, shame on you. Fool me 70 times and counting, shame on me.

Paul Krugman

Paul Krugman, Ph.D., winner of the Nobel Memorial Prize in Economic Science, is an Op-Ed columnist for The New York Times.