Those of you who have been around here since 2009-10 will remember, at heart, I’m a health care policy wonk. If you don’t like health care policy, you may not like this blog for a while :-). That said, good takes from Yglesias and Chait. First, Yglesias:
Policy-minded conservatives have serious criticisms of President Obama’s health care law. They think it taxes rich people too much, and coddles Americans with excessively generous, excessively subsidized health insurance plans. They want a world of lower taxes on millionaires while millions of Americans put “skin in the game” in the form of higher deductibles and copayments. Exactly the opposite, in other words, of what Republican politicians have been promising.
And this, more than tensions between the conservative and moderate flanks of the caucus, is why the prospect of actually legislating has brought the GOP to a crisis point. The chasm between what they’ve been saying they want to do and what their policy ideas actually do is simply much too large to be bridged.[emphases mine]
Republican leaders and conservative intellectuals, for the most part, didn’t really believe nonsense about death panels or that Obama was personally responsible for high-deductible insurance plans. What they fundamentally did not like is that the basic framework of the law is to redistribute money by taxing high-income families and giving insurance subsidies to needy ones. The details matter enormously to everyday people, but the broad principle is enough to make conservatives reject it…
But even the current watered-down version of repeal still has analysis anticipating that millions of people will lose coverage, while the value of the coverage for those who remain is reduced. That leaves the GOP caught between ideological stalwarts who are alarmed by how much of the Obamacare framework the plan leaves in place and nervous pragmatists who are worried about how much suffering it inflicts.
Conflicts between purists and pragmatists are nothing new in the legislative space. But the profound dishonesty underlying the repeal campaign makes this something special. It’s not a question of half a loaf versus holding out for the whole thing. It’s a question of whether Republicans should try to deliver on their ideas or try to deliver on their promises, in a world where their ideas are antithetical to what they’ve promised. And there’s no way out.
Yep, yep, yep. And Chait:
The Republican Party in its modern incarnation is incapable of writing a decent health-care bill, if we define “decent” to mean both some level of technical competence as well as morally decent. That inability has been clear to the party’s outside critics for many years. Republicans have fervently denied this, and probably believed their own denials. As a result they locked themselves into a course of action that forced them to propose a bill on a deadline. They seem to have realized the impossibility of the task midway through, but, unable to retreat on their commitment, they instead rushed out a plan that is shambolic and cruel…
So, because Republicans have spent years dismissing it as tyranny, Trumpcare has to eliminate the individual mandate. They came up with a different kind of penalty for going uninsured. If you go two months without coverage, then insurers are allowed to charge you 30 percent if you want to buy back into the system. Republicans may think this is a clever way to penalize people for going uninsured. It is likely to fail to accomplish its purpose, or even to backfire. People lose their coverage all the time. If you’re facing a 30 percent rate hike to get back on insurance, then your incentive changes: Now you want to wait until you really need insurance to pay those hefty premiums. In other words, rather than giving healthy people a reason to stay in the insurance pool, this gives them a reason to stay out…
House Republicans have been running a television ad assuring the public they already “have a plan” with wonderful features: “Health insurance that provides more choices and better care, at lower costs. Provides peace of mind to people with preexisting conditions … without disrupting existing coverage.”
Eventually they had told the lie so long it became impossible for them to abandon it. And so Republicans have found themselves frantically scrawling out a hopelessly inadequate solution in order to meet a self-imposed deadline driven by their overarching desire to cut taxes for the rich. “Expanding subsidies for high earners, and cutting health coverage off from the working poor: it sounds like a left-wing caricature of mustache-twirling, top-hatted Republican fat cats,” writes the Republican health-care adviser Avik Roy. The caricature is true.