The GOP’s Preexisting Condition

 

It is not true that the preamble of the Senate Republican health care plan consists solely of a villainous mustache twirl. Nor does it conclude with an evil cackle. In between, though, the bill is cartoonishly mean spirited. Here’s the short version: It proposes chucking millions of poor people off of their healthcare plans while providing a massive tax break for the rich. It does raise the question of who, exactly, Mitch McConnell had in that secret lair writing this thing.  Dick Dastardly and Gargamel, maybe?

Enough of McConnell’s own troops blanched at the bill’s kid show villainy that a vote planned for this week was immediately punted to sometime else. After months of secret confabs and assurances of a bigger-er and better-er healthcare plan, the Senate Republicans basically said screw it and belly flopped into the same steaming pile of political doo-doo their House colleagues just perfumed themselves with. Whatever the ultimate fate of healthcare reform in this Congress, both chambers have now made one thing crystal clear: Despite years of high-horsing on the issue, the Republican Party doesn’t have a freakin’ clue about what it should do about healthcare. It is pretty unanimous in proclaiming that Obamacare must go. But as lots of people like lots of parts of Obamacare–no preexisting conditions, keeping kids on parental plans, and retaining Medicaid expansion—making it go without ticking off a lot of people is getting increasingly hard.

What congressional Republicans are trying to do doesn’t make a whole lot of political sense. The basic task they’ve set for themselves is to replace an increasingly popular program with something that is definitely different, but tries to do the same thing, at least enough so that people won’t notice the new plan leaves the elderly, the infirm and the poor less well-off while benefiting the wealthy.  Hmm. Good luck threading that needle. Thus far, the strategy of repeal and replace advocates basically boils down to promising moonbeams and bubble love while delivering not just tough medicine, but not much medicine at all. The GOP rhetorically favors what it legislatively opposes. It is entirely against Obamacare, but is for its central policy objectives. It is against people losing coverage, but crafts legislation guaranteeing that they will. It promises a better plan, which is so bad that it doesn’t want anyone to read it. How the heck did the Republican Party managed to paint itself into such a ridiculous corner?

Well, here’s the scoop. It’s no secret that the Republican Party doesn’t like Obamacare. What seems to have gotten lost in all the through-the-looking-glass world of healthcare politics is that the Democratic Party didn’t like it much either. If you actually want to understand the risible, farcical state of healthcare politics in the United States, that’s a critical and often overlooked fact. The fight over Obamacare is not, as it is so often portrayed, a battle between the left and the right. It’s the left trying to get the right to take yes for an answer, while the right absolutely refuses and instead insists on going through with an epic self-inflicted ass whooping.

What the Democrats really wanted was not Obamacare. What they wanted (and still want), was a universal, single-payer system. In other words, something where you’d be dunned a payroll tax which would support a sort of Medicare for everyone program. Most other industrialized democracies have some version of this. Yet back in 2009/10, even in the warm after-glow of their freshly minted congressional majorities, Dems knew they were never going to get what they wanted. Single-payer smacked of socialized healthcare, which guaranteed full-throated Republican opposition and made the politics, at best, tricky. But single-payer also threatened the interests of a lot pretty powerful groups—insurance companies, for-profit hospitals, swaths of healthcare professionals—who saw that approach as diminishing their livelihoods, or even extinguishing them entirely. That made the politics not just tricky, but pretty much impossible.

So back in 2009 the Dems controlled Congress and the White House—just like Republicans do now—and they wanted to do something about healthcare. They especially wanted to do something about the millions of Americans who had no coverage at all, but their preferred policy, a single-payer system predicated on compulsory social insurance payments, was a non-starter. So what Plan B that might actually be feasible? What the Dems hit on was, wait for it, a Republican plan. That became what we know as Obamacare. It’s true. The basic ideas behind Obamacare had been floated for decades by the GOP. Back in the 1970s the Nixon administration tried to push a program that looks very much like Obamacare. In the 1990s a Senate plan was backed by a who’s who of Republican heavy hitters that, among other things, proposed individual mandates, insurance markets, subsidies for those who couldn’t afford premiums, and a ban on preexisting condition exemptions. In 2006 Massachusetts actually adopted a state-level forerunner of Obamacare, requiring all its citizens to purchase health care, providing subsidies for those who couldn’t afford coverage, and mandating employer provide plans. The governor who championed it was Mitt Romney, the 2012 Republican Party presidential nominee.

All the stuff that the Obamacare repeal and replace squad has railed against for years – the individual mandate, a massive expansion of the federal Medicaid program, scads of government dough to subsidize insurance premiums – are mostly Republican ideas. Don’t take my word for it. Fox News said more or less the same thing. For Democrats Plan B was largely Republican Plan A. The Dems tried to shoehorn something in between those two points on the not entirely nutso assumption it provided a shot at substantive bipartisan reform.

Didn’t work out that way, did it? The Republican Party was all for its ideas unless Democrats—especially Obama–were also for them. They sure as heck weren’t taking yes for an answer from that crowd. So the GOP took powder, had a hissy, and, pretty cynically, went after the major legislative achievement of Obama’s first term with spectacular alternative-facts like Sarah Palin death panel fairy tales.

Completely cooked up horror stories aside, the truth is there’s plenty to criticize about Obamacare. Even for its supporters it has always been viewed as more of a least bad feasible option rather than an end all and be all. But it’s hard to make any improvements if one side resolutely insists the entire thing reads like the script of Omen III, even if that same side wrote most of the script. And that’s pretty much how the GOP got itself in the fix it is in. It hasn’t got any better ideas than Obamacare because Obamacare was its best healthcare idea. This whole wave-the-bloody-shirt, anti-Obamacare crusade has, no doubt, been politically useful, but it also means the Republican Party has spent the better part of a decade knocking the stuffing out of its own thoughts and theories on healthcare policy.

It’s slowly seems to be dawning on GOP leaders (President Trump excepted) that it might not have been such a good idea to make its most promising healthcare policy proposals politically toxic. They have screamed long and loud that Obamacare is a disaster and given a chance they’d prove they can do better. That got them out of the political wilderness. But now they are out of ideas.

They may also find themselves out of luck. The standard GOP policy fallback—whatever the problem is, cut taxes—is not going to work here. The Republican Party had a good political run by demonizing Obamacare. That’s about to end because the electorate called its bluff and said, “okay you win, whaddaya you got?” The answer they’ve come up with–a waffle between warmed over Obamacare and Dickensian-levels of cold-heartedness—is not exactly what the doctor ordered.