Video: Paul Ryan tries to sell the House GOP health-care bill via Powerpoint

A good sign of the state of political debate in America comes between 12:00 and 13:05 below, when Ryan tries to explain a problem with ObamaCare. You’ve got a small number of people with preexisting conditions whose care is very expensive yet who must be insured and who can’t be made to pay premiums beyond a certain amount stuck in the same pool as a larger number of healthy young people who are effectively subsidizing them. That drives up the costs incurred by the healthy, which is why so many are struggling to pay for ObamaCare. To which the left, viewing those 65 seconds in isolation, replies: Durrrrr, the healthy paying for the sick is how insurance is supposed to work.

I’m pretty sure Ryan knows what insurance is. What insurance is, traditionally, involves an assessment of risk: The greater the financial risk your coverage presents to the insurer, the more you have to pay to make it worth their while to cover you. And if you forgo insurance and then get sick, presenting the insurer with a guaranteed net loss in covering you, they’re under no obligation to issue you a policy — again, under traditional insurance. The point Ryan is making about O-Care is that it eliminates all of those risk variables for people with preexisting conditions. The insurer has to cover them by law and can’t charge them a premium commensurate with the risk they pose; it’s left to the healthy to make up that additional shortfall. Watch beyond 13:05, which practically no one on the left did, and you’ll see his alternative — he wants to separate people with preexisting conditions from the general risk pool and put them in a subsidized high-risk pool by themselves, leaving the healthy to form their own, much lower-cost pool. Whether that’ll work or not to cover the sick is debatable — there’s reason for skepticism — but the “Ryan doesn’t understand basic insurance!” argument works better in an age of social media than grappling with his point does. Better to dismiss your opponents as imbeciles than to take them seriously.

Anyway, take advantage of the slow news day to watch the Trump/Ryan case for passing the bill. He mentions at one point that the GOP plan is a “three-pronged approach,” a point Trump has also made. The third prong, a bill to let people purchase plans across state lines, could be introduced as early as next week if what Trump told conservative activists last night is true. If so, that’ll help with PR on the right, which supports lifting the artificial state-lines barriers to coverage. Minor problem, though: They can’t pass that bill with 51 votes via reconciliation. They’ll need to overcome a Democratic filibuster, and I … don’t see how they’ll do it. If they got the current House GOP bill through Congress and onto Trump’s desk and then introduced the second bill a few months from now, that might give red-state Democrats like Joe Manchin enough political cover to tell the left, “Well, now that ObamaCare has been replaced, I might as well vote for this second bill to give people more options.” But how can you ask Manchin to support the second bill when the political heat over the first one is still nuclear-hot right now? And if I’m right that Democrats are going to kill the second bill by filibustering it, what’s the argument for passing the first bill? If the GOP plan is based on three prongs and one of those prongs is impossible, why not scrap the whole thing?

Which is what Tom Cotton, normally a Trump ally, wants to have happen:

Either Trump and McConnell expect the new bill about buying insurance across states lines to tank the repeal effort or McConnell’s planning to attach it to some must-pass appropriations bill and dare Democrats to filibuster that, knowing that it’ll risk a government shutdown. Stay tuned.

By the way, the Brookings Institution estimated today that up to 15 million people could lose coverage under the GOP bill over 10 years thanks to the repeal of the individual mandate. Republicans can shrug that off and say “liberal think tank.” If the coming number from CBO is anywhere in that ballpark, the shrugging won’t be so easy.

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