Alan Zendell, March 16, 2017

Game theory defines a zero-sum game as any situation in which all gains and losses must balance each other exactly. When all the inputs and outflows are added up there can be no net gain or loss. The concept of insurance is based on that principle.

If we apply it to Congress’ attempt to re-write national health care policy, it’s obvious that there is no way they can craft a bill that delivers what President Trump promised. I know I’ve said this before, but to get a clear picture of what’s happening, you essentially need to ignore everything you read and hear, and just think. If more people are covered it’s going to cost more. If fewer people are covered it will cost less.

Republicans in Congress are being torn in opposite directions by those who believe Trumpcare is too generous and those who think it’s not generous enough, and that’s based on a starting point, according to the CBO, of ultimately covering 24,000,000 fewer people than Obamacare. Even if the warring forces cancel each other out, we’re still left with a health care system that has glaring holes in it.

Like a lot of people who’ve spent the last few months shaking their heads, I looked to Paul Ryan to steady the ship. But yesterday, he defended the new bill in terms of not forcing people to buy what they don’t want. The idea was that it’s a good thing that Trumpcare doesn’t cover as many people, because some of them don’t want to buy coverage at present costs, anyway. Am I the only one who sees the absurdity of that argument? Several years ago, when gasoline prices were exploding, some oil industry advocates said, “So what if gas goes to six or seven dollars a gallon? People who can’t afford it simply won’t buy it and the problem will solve itself.” No, it won’t.

A key provision of Trumpcare is turning Medicaid over to the states, something conservatives have been arguing for decades. In effect, what they’re trying to do is set the clock back sixty years. Following World War II, with the Great Depression finally over, states had complete discretion in determining who could request government assistance in health care, housing, and putting food on the family table. Some states, notably the northeast, the rust belt, and the west coast took a progressive approach, while the rest did everything possible to reduce public assistance. When the Supreme Court ruled that states could not impose prior residency requirements on people asking for assistance, there was a mass migration of people in poverty to the more generous states. Welfare and medical assistance rolls skyrocketed in most large American cities, while the more affluent taxpayers fled to the suburbs.

To stem those tides, the social legislation of the sixties required that all states adhere to minimum standards of care. No longer could some states turn a blind eye to people in legitimate need and ship them off to someone else’s rapidly growing urban slum. If Congress throws in the towel and returns public assistance to the states with no federal oversight, we’ll be back where we were in the fifties. When I hear people ask why their taxes should pay for other people’s health care, my first reaction is that they’re selfish. Worse than that, they’re shortsighted about their own future.

Treating health care as a zero sum game must, in the end, result in what I described above. The problem is that it’s not a zero sum game – it’s worse. This administration wants to significantly increase the military while cutting taxes for the wealthiest Americans. That will drain even more resources from the programs nearly half our population depends on. They’re already stripping the EPA and the Department of Education bare, but those agencies’ budgets were never large to begin with. The real money the right wing salivates over is in Social Security, Medicare, and Medicaid. And while we’re fighting to save those programs there are other things we can’t lose sight of.

Where will women turn when Planned Parenthood has been decimated? How are we going to make it possible for average kids to get an education beyond high school without going into debt for the next twenty years? And what about our veterans? Remember all those promises during the campaign? Have you heard a word about caring for them?

We’ve lived through this cycle before. Are we going to let it happen again to satisfy the greed of the far right?