The Middletown Press (Middletown, CT)
Don’t blame President Donald Trump for the Republican health care disaster
President Donald Trump didn’t know that health care could be so complicated, or whether, as he’s alternately described it, his own party’s plan was either “terrific” or “mean,” or that it was on the verge of collapse this past weekend while he was watching nine hours of golf.
But it’s still not his fault the Republican health-care effort fell apart.
This isn’t just true according to Trump’s internal logic that he deserves credit for good things that have only happened in his imagination but not blame for bad things that have happened in real life. It is actually true. Trump isn’t the reason that Republicans haven’t been able to repeal and replace Obamacare. All of the lies they’ve told are.
But first let’s set the scene. After over seven years of railing against Obamacare, Republicans this week finally thought they’d figured out what they needed to replace it: two more years to decide on a health-care plan of their own. That, at least, is what Senate Majority Leader Mitch McConnell basically said after the GOP’s latest health-care bill couldn’t muster the 50 votes it needed to just come up for debate in the Senate. So instead of trying to repeal and replace Obamacare all at once, they would settle for repealing it today and seeing what they could come up with in some distant tomorrow.
But it didn’t take long for them to find out they didn’t have the votes for this either. Which is to say that they couldn’t even agree on having a plan to have a plan. They’re one level away from that. They only have a plan to have a plan to have a plan.
Why haven’t they been able to do better than this? Well, when they were out of power, Republicans didn’t really bother with health-care policy because they didn’t want it to get in the way of their healthcare politics. Nobody can attack a plan that doesn’t exist, or, more to the point, project how many tens of millions of people would lose health insurance as a result of it.
But now that Republicans control the government, their previous health-care politics are getting in the way of their health-care policy. In other words, they prioritized slogans over solutions - “repeal and replace,” instead of the specifics of what that would mean - and now those slogans are making it harder to come up with solutions.
The important thing to understand is that health care is all about trade-offs. If you’re going to help poor and sick people get covered, like Obamacare does, then you’re going to have to make rich and healthy people pay more. Which, of course, implies that if you’re going to let rich and healthy people pay less, like Republicans would, then you’re going to have to take insurance away from poor and sick people. Now, as you might have guessed, Republicans aren’t exactly eager to admit that their plans would create losers of their own — and very sympathetic ones at that — so they’ve tried to avoid talking about it when at all possible, and only used the vaguest terms when not. That’s why they talk in buzzwords like “choice” and “competition” and “patient-centered care” rather than getting into the particulars of their plan. It’s been slightly more nuanced than Trump’s promise to come up with “something terrific,” but not much more.
But more than that, Republicans have attacked Obamacare for doing things their own plans would do even more. Speaker of the House Paul Ryan, for example, has assailed Obamacare’s “soaring deductibles” despite the fact that the Republican plans would make them go up far, far more. Indeed, the nonpartisan Kaiser Family Foundation estimates that someone making $18,090 or less would see their deductible go from an average of $255 under Obamacare to $6,105 under the Senate bill. It was the same sort of thing when Health and Human Services Secretary Tom Price criticized Obamacare for still not covering 28 million people. He somehow neglected to mention that the Republican plans would add another 22 million to 32 million people to the ranks of the uninsured.
Republicans, then, have put themselves in a tough spot. After all, it isn’t easy to pass a bill that does the opposite of what you said it would. You can try to pretend you never said those things, like House Republicans did when they retroactively erased their pledge to protect people with preexisting conditions from being charged more. Or you can bash the independent experts who point out what your plan would actually do, like the Trump administration did when it denounced the Congressional Budget Office’s allegedly inaccurate numbers without explaining what was supposed to be wrong with them. But none of that changes the fact that you’ve sold your bill under false pretenses. Eventually people will figure that out.
Republicans didn’t become worse at health care on Jan. 20, 2017. They became worse at it on Jan. 20, 2009. Before then, they had thought that mandating everyone buy insurance and subsidizing it for anyone who couldn’t was the sensible centrism Gov. Mitt Romney had tried in Massachusetts. But after that, it became the unconstitutional socialism President Barack Obama wanted to foist on the rest of the country. Since then, Republicans have insisted against all evidence that Obamacare is variously “imploding” or “exploding” or killing jobs, but it’s not.
It’s working. Maybe not as much as it could be, in part, as the Center for Economic Policy and Research’s Dean Baker points out, because a lot of red states have undermined it — but it’s working nonetheless. The government has covered around 22 million people for about as much as it thought it would cost. Republicans, though, have tried to deny this, and, as a result, deny what their own plans to get rid of it would do. Instead, they’ve attacked the things they would make worse, and pretended they wouldn’t make them worse by promising to do the impossible.
Who does that sound like?
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