AHCA-palooza

Wow.  I’ve been saying for a long time that Republicans had basically given themselves an impossiible task, but, still, I didn’t expect themselves to embarrass themselves this badly.  So many reason for this failure (and huge win for the American people).  But, as I’ve been thinking about it, I really do think the core of it is that we already have a conservative version of health care reform– it’s called Obamacare.  This legislation was, from the start, built upon ideas from the Heritage Foundation, and working with existing markets in the hopes of crafting genuinely bipartisan legislation.  Obama worked his ass off to get Republicans, but they simply decided to oppose everything he did as a matter of principle.

So, we end up with the ACA, which Republicans unanimously opposed and endlessly bad-mouthed.  But it is, in large part, a conservative vision of health care reform.  But, if they’ve mercilessly bad-mouthed actual conservative reform, where does that leave them to go?  Well, the Freedom Caucus of 2010 status quo health care that pretty much nobody else actually wanted, or a stupendously incoherent vision of health care reform offered by Ryan and pals.  Neither of those are remotely political palatable– hence, the crash and burn.

Anyway, lots of smart writing on this.  A sampling:

1) Jon Bernstein on Republicans allergy to thinking seriously about policy:

Really, however, this is only the latest climax of a long cycle of Republican dysfunction which dates back to George H.W. Bush’s administration, when House radicals upended Bush’s budget deal with Democrats in a dramatic floor vote.

Those radicals, led by Newt Gingrich, eventually took over the Republican conference in 1995, and promptly shut down the government twice. They stripped the House of the resources it needed to legislate, and committees of their institutional memory by term-limiting their chairs. They capped it off with an irresponsible impeachment of a popular president. After that, Gingrich was gone, but the Republican House just got worse, with a decade marked by repeated mismanagement and corruption.

When Republicans regained their House majority in the 2010 election, they had a chance to change their ways, but they showed they were no different, even shutting down the government again.

Meanwhile, despite pledging as soon as they took office to write a bill to replace Obamacare, they never bothered to do the hard work of actually putting together a policy. Oh, there are real conservative health ideas out there. But the party as a whole, and the House in particular, just didn’t bother. And it’s not just health care: They can’t, or won’t, create viable policy. There’s no Republican immigration bill, no Republican replacement for Dodd-Frank, and on and on. They rarely even manage to talk policy beyond cliches and symbols.

2) Ezra, who has been more indispensable than ever this week:

Let’s be clear about what happened here. The American Health Care Act failed because it was a terrible piece of legislation. It would have thrown 24 million people off insurance and raised deductibles for millions more — and the savings would’ve gone to pay for tax cuts for millionaires. It broke virtually all of Donald Trump’s campaign promises, and was opposed not just by Democrats but also by Republicans.

Big policy change is hard. The modern Republican Party has built itself in opposition. Paul Ryan won fame designing budgets that were never meant to pass, and by criticizing Barack Obama. Donald Trump established himself as a political force through his leadership of the crackpot birther movement. This is a party that has forgotten how to do the slow, arduous work of governing. Perhaps it’s worse than that. This is a party, in many ways, that has built its majority upon a contempt for the compromises, quarter-loaves, and tough trade-offs that governing entails. They need to learn from this defeat, or they are doomed to repeat it, and repeat it, and repeat it. [emphases mine]

3) Chait:

The right’s insoluble problem is that people who have insurance like it. Employer-sponsored insurance is popular. Medicare is popular. Medicaid is popular. To the extent that the exchanges in the ACA are not that popular, it is because they are less like those forms of insurance and more like the kind of insurance conservatives prefer — they have higher deductibles, more price discrimination between old and young, and more market competition. Any employer-sponsored insurance plan is going to cover essential health benefits. It’s going to charge the same price to the young and the old alike. In other words, it is going to spread the risk of needing medical care throughout the population it covers.

Conservatives disagree philosophically with the very concept of insurance as most Americans experience it. Insurance means spreading risk, which is a form of redistribution. Republicans postured against Obamacare from the left, denouncing its high deductibles and premiums, and promising a better, cheaper plan that would cover everybody. Their plan, inevitably, did the opposite. All politicians overpromise, of course. But the Republicans did more than overpromise. They delivered a policy directionally opposed to their promises.

It is not possible to write a bill that meets public standards for acceptable health-insurance coverage within the parameters of conservative ideology.

4) Michael Tomasky:

But in Republican-Ryanesque-Randian ideology, the individual mandate was evil, and the subsidies of course were horrendous. So they absolutely had to go. But, Republicans promised, we’ll keep the pre-existing conditions thing, because people like that! And we don’t want to look heartless.

 But it is impossible to keep that without the other two “legs of the stool,” in the parlance. Impossible. I give the Freedom Caucus people this much credit: They at least were honest enough to say hey, we don’t mind seeming heartless at all—we want to get rid of the pre-existing conditions thing too! But that wasn’t something leadership could embrace politically. So Ryan and all the Republican leaders have been peddling a lie to the American people for seven years, telling them they could have this wonderful thing and could have it for free. Conservatives are supposed to know better than liberals that nothing is free.

5) Love how Jeet Heer sticks it to Paul Ryan:

Trump’s big mistake was not just political—thinking that Ryan could muster the votes to pass the law. It was also a matter of policy—believing that Ryan actually had some idea of what a good plan would be. But it’s not just Trump that got bamboozled. Almost everyone in American politics has bought into the idea that Ryan is a pillar of GOP competence and seriousness…

Trump shouldn’t feel too bad: He’s not the first to be fooled by Ryan. The Speaker, not the president, is the greatest political fraud of our time. It’s been Ryan’s triumph to fool people all over the political spectrum (liberals and centrists as well as conservatives) into thinking that he’s a different sort of Republican, a policy maven with a genuine mastery over numbers who can grapple with the policy thickets of the tax code and health care. Unlike demagogues like Sarah Palin or Trump, Ryan was someone who eschewed dishonest and polarizing rhetoric in favor of honest debates about the issues. You could disagree with Ryan, so popular folklore went, but he was someone you could have a real policy discussion with…

Ryan has been a scammer all along. He’s not a more serious Republican who offers a welcome relief from the frothing of the Tea Party. He’s an Ayn Rand acolyte who fully shares the agenda of the hard right on economic matters. And his long con is now obvious for all the world to see. “Never give a sucker an even break,” W.C. Fields used to say. Anyone who continues to think of Paul Ryan as a legislative wizard or a serious policy thinker richly deserves to be called “sucker.”

6) A true must-read from Frum:

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

Whatever else the 2016 election has done, it has emancipated Republicans from one of their own worst self-inflicted blind spots. Health care may not be a human right, but the lack of universal health coverage in a wealthy democracy is a severe, unjustifiable, and unnecessary human wrong. As Americans lift this worry from their fellow citizens, they’ll discover that they have addressed some other important problems too. They’ll find that they have removed one of the most important barriers to entrepreneurship, because people with bright ideas will fear less to quit the jobs through which they get their health care. They’ll find they have improved the troubled lives of the white working class succumbing at earlier ages from preventable deaths of despair. They’ll find that they have equalized the life chances of Americans of different races. They’ll find that they have discouraged workplace discrimination against women, older Americans, the disabled, and other employees with higher expected health-care costs. They’ll find that their people become less alienated from a country that has overcome at last one of the least attractive manifestations of American exceptionalism—and joined the rest of the civilized world in ameliorating and alleviating our common human vulnerability to illness and pain.

7) This Joe Barton quote is so telling.  They’ve just been playing games.  Governing is serious.

8) And this David Leonhardt thread is spot-on.

Whatever happens with health care from here on, remember, there’s nothing on the horizon to change the underlying dynamics that doomed this repeal and replace effort.  The American public absolutely does not want a return to pre ACA health care (and Republicans spent years and years lying that they would bring lower premiums and deductibles) and within their own party, the Republicans are hopelessly divided (and amazingly ignorant) on health care policy.

Advertisements

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

5 Responses to AHCA-palooza

  1. Jon K says:

    This piece from Frum is excellent. If republicans embraced the thinking of people like Frum, then I would most likely still be one. Instead the party moved toward becoming the modern day Know-Nothing Party, and I want no part of that.

    • Steve Greene says:

      Yep! That’s why I love Frum. We actually have some meaningful disagreements, but he’s open-minded and reality-based. We are so much better off as a country when we have two, rather than one, reality-based political parties.

  2. Jeremy Tarone says:

    Did anyone expect anything else but cynical manipulation from people who call themselves the “Freedom Caucus”?

  3. R. Jenrette says:

    The Freedom Caucus members won by getting Trump to blink and to give in instead of making them vote. If they had to put their name on the record they would have been portrayed as rogue Republicans who wouldn’t vote to end Obamacare.
    Enough Republicans could have changed to a yes when asked to actually vote to pass the bill, even though it seemed unlikely. This way they didn’t even have to go on record.
    Surely everyone thinks Trump (and Ryan) lost on the AHCA so an actual vote wouldn’t have made perceptions worse. But Trump drew the red line and then backed down. That’s worse.

    • Steve Greene says:

      The stupid thing is that was never Trump’s line to draw! President can’t call for a vote in the House, that’s the Speaker’s job. Ryan was not just going to do Trump’s bidding for him.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: