Hanlon’s Razor On Capitol Hill
US health care’s saving grace is the incompetence of its enemies
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“Never attribute to malice that which is explained by stupidity.”
— Robert J. Hanlon (probably)
Anything’s possible
Somehow, the Affordable Care Act is still the law of the land in the United States. Despite six long years of railing about the need to repeal Obamacare (and yes, for the dolts out there, these are the same thing), dozens of attempts to do so, and majorities in both houses of Congress, the Republican Party came up short this week.
Two signs that the road block might be more permanent this time:
- President Trump is acting even more like a toddler’s idea of a Game of Thrones villain than usual on Twitter, suggesting he’d let Obamacare fail in order to . . . demonstrate that Obamacare will fail; and
- Breitbart had no snappy comeback other than to turn on leaders in the House, the Senate, and the Obama administration to excuse Sunkist King Joffrey’s incompetent rule.
The Monday-night revival of the ACA came as Sen. Mitch McConnell seemed to have hit on a winning strategy: make “reform” as crude as possible to please statistical serial killers like Ted Cruz and bribe the moderates with up-front payments. All of this as President Trump inexplicably wined and dined Senators who, crucially, were not key swing votes. One guesses this is what business leaders would do and not politicians.
And then Senators Jerry Moran of Kansas and Mike Lee of Utah announced their joint opposition to the bill Monday night. As neither is a bleeding heart liberal in GOP terms, they likely provide cover for colleagues unhappy with the legislation but wary of the insane clown posse that is the Republican primary voter base (with apologies to actual juggalos).
For all the ACA’s unevenness and shortcomings, it can not be stated enough that it actually helped people overall. It may not enjoy the ironclad support base of a self-aware social group like Medicare has in senior citizens, but the tangled web of interests the ACA caters to has mobilized groups to its defense across the country’s political spectrum. Even the Catholic Church, which chafed against ACA requirements perceived as anti-Catholic, and insurance companies, who’ve helped to undermine the exchanges that keep the ACA workable, both publicly condemned the House and Senate attempts at repeal. Thousands of activists and volunteers — including Indivisible chapters across the country — mobilized support in favor of the ACA and against its inferior replacements through countless phone calls, emails and outreach events.
We’ve been on a soapbox elsewhere about the very real harm posed by this bill in broad political terms and we wouldn’t be the first to point out that this development is by no means a sign of a brighter immediate future for the ACA. Likewise, now is not the time for scoring cheap political points. We don’t need another gag-inducing moment like the “Hey! Hey Hey! Goodbye!” chanted by House Democrats after the passage of the AHCA.
Still, It’s hard to avoid the fact that the failure to make much progress in the assault on the ACA is a massive blow for the GOP-held Congress and the present tenants of the Executive branch. At last, there seems to be a limit to the effectiveness of blatant lies to convince people that blowing up a sixth of the US economy and gambling with millions of people’s lives is responsible policy. Welfare programs are supposed to grant certainty, to smooth out life’s vicissitudes so a broken leg doesn’t mean bankruptcy and families don’t have to choose between providing for themselves and meeting grandma’s nursing home bills. As Senator Capito (R-WV) so eloquently put it today, Senators “didn’t come to Washington to hurt people.” Or, rather, they shouldn’t have.
Being the Party of No is great so long as you have somebody to block. Lacking that, the GOP has shown it has no actionable ideas about how to improve the lives of ordinary Americans. Waxing poetic about economic change, community values, duties, and the virtuous life, as Republican congresspeople are wont, matters little when your legislative agenda is to rush tax cuts for the rich over the corpses of the uninsured.
A silver lining to the Democratic Party’s ongoing inability to get its act together is that the far-right counternarrative that continues to blame Democrats of “obstruction” may be a slightly harder sell.
But then again, who knows? Perhaps Donald Trump will petulantly take an axe to whatever he can reach of the ACA’s programs and, standing amidst the wreckage, lie and lie and lie again that it was inevitable. Perhaps Mitch McConnell will manage to bribe everybody with enough off-the-books bonds that the party of small government can take us far, far deeper into the red in the name of tax reform. Politically speaking, anything’s possible.
Andrew Leber is based in Boston.
Middle American Roulette
This political volatility has consequences. Consider the American health care industry as a person playing Russian Roulette. Pulling the trigger on legislative ACA repeal may have revealed an empty chamber, but there are still more cylinders.
Premiums are still increasing at rates that many insured in rural states find unacceptable. Insurers like Humana and Aetna, previously concerned the ACA wouldn’t exist by the end of fiscal year 2016–17, pulled out from participating in ACA markets in 2018, which will limit competition and thus raise prices further; it’s unclear whether the failure of repeal efforts will entice them back for 2019.
As David Chen’s mentioned in these pages, the markets at the heart of drug provision are an oligarchic cesspool of crony capitalism and advanced theoretical price gouging. Doctor and nurse shortages, particularly in rural areas, continue to hobble our capability to perform cost-saving preventative care. Regional hospital monopolies are crushing independent providers and lobbying to make it more difficult to construct new healthcare facilities, effectively cementing the primacy of their buying power. Rampant miseducation and conspiracy theories by the likes of FoxNews, Alex Jones, and Breitbart discredit vaccines specifically and scientific professionals generally. Rural communities are weathering waves of opiate abuse, alcoholism, and suicide driven by economic and cultural despair.
In a sane country, with a sane conservative party, these would be easy hurdles to surpass. Making compromises to entice insurers back to the exchanges would create a more competitive market, drive down premiums, and keep federal subsidies for the insured in check. Reforming copyright law and breaking up trusts in the pharma industry would create a freer, more productively competitive, market. Similar trust-busting practices in regional hospital monopolies could help give health ‘consumers’ more meaningful agency in choosing where they receive care. Encouraging investment in alternative energies, which are poised to be a massive growth market and could take advantage of rural areas, could bring jobs and meaning back to rural areas deprived of it by globalization.
These are market-minded healthcare solutions that would be acceptable to Democratic lawmakers and constituents because they endeavor to improve the health of the population instead of punishing it when it falls sick. They are some of the ideas the GOP could’ve floated over the last seven years. They are not the ideas of the GOP today.
What ideas does the GOP claim? Lies, mostly, and unquestioned power to themselves.
Can our government be considered the people’s when it seems controlled by cruel men that want to sell citizens’ health piecemeal to the business interests of campaign donors? What is the point of a state that, in this closed auction of the collective well-being, wishes harm upon its constituents? Can you call a party that wants to hoard rights and benefits for itself a party of the people? At what point does a political party devolve into a scam? At what point does a political platform become a blueprint for aristocracy?
I’d argue we’ve passed all these milestones, and still American health care remains in tenuous, functional, limbo. Perhaps it is despite the GOP. Perhaps it is because of them. In an era-appropriate twist of irony, the safest refuge for functional health policy in America today is within incompetence, an incompetence inherent in trying to fit the square block of greed into the circular hole of public welfare.
So tonight, say a cheers to Hanlon’s Razor on Capitol Hill. It may very well be the thing that’s keeping thousands of your fellow Americans alive.
Nicholas Morley is based in Burlington.
