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The big unanswered question from the health care debacle

As everyone knows, last week legislation to replace the Affordable Care Act – aka “ObamaCare” went down in a stunning defeat.   This shocked the political world as getting rid of Obamacare it has been the avowed goal of of the Republicans – almost their “raison d’etre” (reason for being) for the past seven years .  On top of that, President Trump had made it his top priority, pledging to have the act repealed some 64  and even promised to deliver a full repeal of Obamacare  “On day one of the Trump Administration”.
Pundits and political analysts everywhere are looking at this from every possible angle – how could it even be possible that a party controlling all branches of government could fail so spectacularly on what they considered to be their most important goal?   An important question perhaps, but there is an even bigger question – an “elephant in the room” that almost everyone still seems to be ignoring completely.   Why do Republicans have such visceral hatred of ObamaCare in the first place?Let’s think about this for a minute.   Republicans pride themselves in being “pro-business” and by many measures ObamaCare was pro-business.   For one, it is a “market based system” and before this legislation there essentially was no “individual market” – at least not at a rate anyone could afford.   Most startups and small businesses – arguably the “true source of job creation” – are started by sole proprietors, and during their lean early days affordable health care is critical.American corporations have also benefited ans costs finally begin to come down.     Employment based insurance – an accident of history – has long been a “drag anchor” on their profitability.   The cost of employee health insurance, for example, is said to be a significant percentage of the cost of American cars.  This is a cost must be passed onto consumers and since car companies in Europe and Asia do not have to share this burden, it damages the competitive position of American firms.

So why would Republicans oppose decoupling health care from employment?   It is something I have always wondered but never really found a satisfactory answer.  As sometimes happen with this sort of thing, it took a Tweet to bring things into perspective.  Specifically this one by Scott Santen asking that same question and citing a Forbes article that made a pro-business argument to healthcare reform:

The answer to this question takes us to a dark place but one which must be addressed.  Matt Perez, a startup founder in Silicon Valley answered succinctly:

Could that be it?  Health insurance as a form of employee control?  It sounds almost like a conspiracy theory but it just might be true.  It represents the worldview of what we will call, for want of a better term, “the employees ownership economy” – The idea that, for all practical purposes, employers own their employees.  They sometimes pay generously for this – and while employees may have weekends off the employer does essentially own all of their “cognitive energy” and almost all of their free time.

Employees aren’t quite “owned slaves” because they can always quit – and in theory move on to another employer, but what if you have kids or a partner on you medical plan?  Considering starting your own business or independent practice?  Don’t even think about it unless you have this angle covered.

My theory is Republicans never expected a pushback on their plans to destroy the individual market because most of them have had employer based health insurance for their entire lives, and most don’t even see any irony if that coverage has been provided by the government.   Now they need to come to terms with the fact that the number of self-employed – is approaching 50 percent of the workforce.  Being “pro-business” doesn’t mean the same thing it once did.

Updated: March 29, 2017 — 10:04 pm

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