Republicans and the health care mess

You hear it from Republicans, pundits and even some Democrats. It’s often said in a tone of regret: I wish former United States president Barack Obama had done health reform in a bipartisan way, rather than jamming through a partisan bill. The lament seems to have the ring of truth, given that not a single Republican in Congress voted for Obamacare. Yet it is false — demonstrably so.

That it’s nonetheless stuck helps explain how the Republicans have landed in such a mess on health care. The Congressional Budget Office released a jawdropping report last Monday estimating that the Republican health plan would take insurance from 24 million people, many of them Republican voters, and raise medical costs for others. The bill effectively rescinds benefits for the elderly, poor, sick and middle class, and funnels the money to the rich, via tax cuts.

The American Association of Retired Persons doesn’t like the bill, nor do groups representing doctors, nurses, hospitals, the disabled and people with cancer, diabetes and multiple sclerosis. Other than that, Mrs. Lincoln, it’s a great bill.

If Republicans still pass it, they will take political ownership of the flawed US health care system — after making it much more flawed. Senator Tom Cotton (Republican from Arkansas) has said the bill is so bad that it would “put the House majority at risk next year”. On the other hand, if Republicans fail to pass their own bill, they’ll look weak and incompetent, which is also not a good look to voters.

How did the party’s leaders put themselves in this position? The short answer is that they began believing their own hype and set out to solve a problem that doesn’t exist.

Obamacare obviously has flaws. Most important, some of its insurance markets — created to sell coverage to the uninsured — aren’t functioning well enough. Alas, Paul Ryan, Mitch McConnell and US President Donald Trump are not trying to fix that problem. They’re trying to fix a fictional one: Saving America from a partisan, socialistic big-government takeover of health care.

To understand why that description is wrong, it helps to recall some history. Democratic attempts to cover the uninsured stretch back almost a century. But opposition to universal government-provided insurance was always too strong. Even Lyndon Johnson, with big congressional majorities, could pass programmes only for the elderly and the poor — over intense opposition that equated Medicare with the death of capitalism.

So Democrats slowly moved their proposals to the right, relying more on private insurance rather than government programmes. As they shifted, though, Republicans shifted even farther right. Former US president Bill Clinton’s plan was quite moderate but still couldn’t pass.

When Barack Obama ran for president, he faced a choice. He could continue moving the party to the centre or tack back to the left. The second option would have focused on government programs, like expanding Medicare to start at age 55. But Obama and his team thought a plan that mixed government and markets — farther to the right of Clinton’s — could cover millions of people and had a realistic chance of passing.

They embarked on a bipartisan approach. They borrowed from Mitt Romney’s plan in Massachusetts, gave a big role to a bipartisan Senate working group, incorporated conservative ideas and won initial support from some Republicans. The bill also won over groups that had long blocked reform, like the American Medical Association.

But congressional Republicans ultimately decided that opposing any bill, regardless of itssubstance, was in their political interest. The consultant Frank Luntz wrote an influential memo in 2009 advising Republicans to talk positively about “reform” while also opposing actual solutions. McConnell, the Senate leader, persuaded his colleagues that they could make Obama look bad by denying him bipartisan cover.

At that point, Obama faced a second choice — between forging ahead with a substantively bipartisan bill and forgetting about covering the uninsured. The kumbaya plan for which pundits now wax nostalgic was not an option.

The reason is simple enough: Obamacare is the bipartisan version of health reform. It accomplishes a liberal end through conservative means and is much closer to the plan conservatives favoured a few decades ago than the one liberals did. “It was the ultimate troll,” as Michael Anne Kyle of Harvard Business School put it, “for Obama to pass Republican health reform”.

Today’s Republican Party has moved so far to the right that it no longer supports any plan that covers the uninsured. Of course, Republican leaders are not willing to say as much, because they know how unpopular that position is. Having run out of political ground, Ryan, McConnell and Trump have had to invent the notion of a socialistic Obamacare that they will repeal and replace with ... something great! This morning they were also left to pretend that the Budget Office report was something less than a disaster.

Their approach to Obamacare has worked quite nicely for them, until now. Lying can be an effective political tactic. Believing your own alternative facts, however, is usually not so smart.

— New York Times News Service

David Leonhardt is the managing editor of a New York Times website covering politics and policy.