AHCA– the stripped-down Chevy Cruze of health care

Been reading lots of good stuff on the Republicans incredibly misguided repeal and replace efforts.  Here’s my tortured analogy.  Obamacare is a car.  Not a great one, say a Chevy Cruze.  Gets the job done, but surely much to be improved.  Problem is, lots of Republicans think the car should not exist.  Other Republicans are unwilling to take the whole care away because of the obviously negative political implications (and, maybe to some small degree, some of them actually care some little bit about human suffering of their fellow Americans).  But they’ve got to do something.  They’ve promised.  And, damnit, Trump needs a win.  So, what to do we get?  A Chevy Cruze where they’ve traded in the fuel injection for a carburetor.  Downgraded the 6-speed transmission to a 3-speed.  Replaced the automatic windows with old style cranks (like my beloved 1992 Geo Prizm).  Oh, yeah, and sold off the back seat so rich people can have a tax cut.  But, hey, it’s something, it’s “repeal and replace.”  There your Republican health care.

Some various good stuff…

1) The NYT Editorial nails it: a bill in search of a problem:

It also reflects a fundamental reality: Unlike President Barack Obama, whose clear objective was to expand access to medical care, the Republicans have no coherent idea or shared vision of what they want to achieve and what problem they mean to solve.

Do they want to cover nearly as many as are covered under the A.C.A.? A few senators, like Susan Collins of Maine and Bill Cassidy of Louisiana, say they do, but a majority from the party are not willing to spend the money that would be needed to do that. Or do they want to significantly reduce government spending and regulation of health care, leaving Americans to navigate the free market on their own? Conservatives like Senator Rand Paul of Kentucky and Representative Mark Meadows of North Carolina are arguing for that, but the rest of the congressional Republicans do not want to go down this treacherous path…

The bottom line: The Republican proposal would not increase “competition and consumer choice” as Mr. Ryan claims. It certainly wouldn’t deliver on President Trump’s promise of “insurance for everybody.” And it wouldn’t be the full repeal of the A.C.A., or Obamacare, that many Republicans have been promising their base for the last seven years. That is why some hard-liners say they will oppose the new bill, which the House is expected to vote on as early as Thursday.

2) Ezra Klein:

This is a trap for Republicans. Both the process and the substance of the American Health Care Act have revealed a political party that has lost sight of the fact that the true test of legislation isn’t whether it passes, but whether it works.

Republican leaders have moved this bill as fast as possible, with as little information as possible, and with no evident plan for what will happen if the bill actually becomes law and wreaks havoc in people’s lives. This is not the health reform package Donald Trump promised his voters, it’s not the health reform package conservative policy experts recommended to House Republicans, and it’s not the health reform package that polling shows people want.

About the only thing that can be said for the revised bill is this might be the health reform package that can pass the House. And that appears to be the only problem Republicans care to solve right now.

3) And this Ezra piece on the health care debate we should be having and are not is great and full of big picture stuff; you should read it:

Reason No. 1: The coherent conservative position on health care is extremely unpopular. The most telling line in Douthat’s column is this one: “Republican politicians may offer pandering promises of lower deductibles and co-pays, but the coherent conservative position is that cheaper plans with higher deductibles are a very good thing, because they’re much closer to what insurance ought to be.”

Consider how remarkable that sentence is. Douthat is saying, sympathetically, that Republicans routinely promise a policy outcome 180 degrees from the one they’re pursuing. As much as politicians are lambasted as spin artists, this level of misdirection is rare, and for good reason — if you build public support for the opposite of the changes you want to make, those changes are unlikely to endure.

There’s a reason Republicans offer such self-destructive promises. Sparer plans with higher deductibles and higher co-pays are extremely unpopular. They’re the most unpopular part of Obamacare, which is why so many Republicans — including Mitch McConnell and Donald Trump — have used high deductibles as a cudgel with which to attack the law.

Republicans have used this unpopularity to their advantage, instead of trying to sell Americans on the advantages of high deductibles and laying the groundwork for the day when they might move the health care system in a more conservative direction. They are paying for that decision now, and they will suffer dearly for it if their plan actually passes.

 

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About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

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