If the mythology of Paul Ryan, cerebral and considerate policy wonk, survives 4 May, it will truly be a miracle. Or just another marker of the punditocracy’s unshakeable idiocy.



Ryan’s Republican Congress, after trying and failing to hold a vote on a repeal of the Affordable Care Act (AKA Obamacare) in March, has rounded up the votes to pass the American Health Care Act, perhaps the worst piece of life-altering legislation to ever see the light of day.

This bill won over a few so-called moderate Republicans because it now includes an amendment that would allow states to waive an ACA rule that forbids charging sick people higher insurance prices, as long as the states set up a special insurance pool for those people. The amount of money allocated for this? A paltry $8bn.

A quick recap: Ryan’s legislation (calling it Donald Trump’s bill gives too much credit to a man wholly disinterested in anything that smells of policy) will scrap the ACA’s mandate to buy health insurance, substantially cut Medicaid, and hope somehow this doesn’t cause premiums to skyrocket.

The nonpartisan Congressional Budget Office (CBO) found that 24 million Americans would lose their health insurance under a version of the legislation considered in March. The CBO hasn’t had the time to score this bill. Republicans aren’t interested in finding out just how much of a disaster they’re going to inflict on regular people. They have a campaign pledge to fulfill, after all.

Were an alien to wander down to Earth and examine the functionality of American democracy in 2017, it would find an intellectual graveyard. Lawmakers tasked with carefully considering remarkably complex legislation with the potential to significantly alter the lives of millions of people are instead rushing to vote for a bill that they know almost nothing about and that no outside expert has had the time to seriously assess. This is insanity.

The healthcare bill will funnel $100bn to states over a decade to stabilize what are sure to be markets wracked by chaos, assuming this legislation survives intact to Trump’s desk. Amendments provide another $30bn to states with few strings attached. If somehow all of this money is used just for the high-risk pools, it will come out to $138bn, which sounds impressive enough. But most healthcare researchers believe a competently run national high-risk pool would cost much more.

Factoring in lifetime caps on coverage and longer waiting periods, one 2010 estimate from two conservative health economists found such a pool would cost $150bn-$200bn over a decade. Other recent estimates believe the price tag to be much higher.

Obamacare itself is far from perfect. Subsidies are too low, deductibles are too high, and people who are not very sick and not very poor have not seen any vast improvement in their healthcare. As popular as it’s been for anyone under the age of 26 to remain on their parents’ healthcare, it also ensures a lot of healthy people aren’t buying insurance, thus driving up costs for everyone else. (Republicans are keeping this provision.)

In a rational society with a quasi-thoughtful legislative body incentivized to not destroy government as we know it, lawmakers would come together to repair the ACA. Republicans would work with Democrats, and the president, invested in the health and success of his citizens, would devote time and energy to addressing our bloated healthcare system’s greatest flaws.

Of course, we’re in this dystopia, not that world, so we’re left with Trump and Ryan’s flock of nihilists. The only good news is that the Republican-controlled Senate must also pass the American Health Care Act, and there’s little chance that such a disastrous bill will survive in its current form. Unlike members of the House, Republican senators are responsible for entire states. As a unit, they’re less susceptible to the worst impulses of their House colleagues.

All Republicans, however, will have to own this mess because their party has total control of government. House Republicans are guaranteed to lose seats next year. The only question that remains is if this bill will be enough to drive them out of a majority that not so long ago seemed impregnable.

More importantly, the American Health Care Act will belong to Ryan’s legacy. This is his House. And it deserves to fall.