Still Deathcare
The secretive clan of white men deciding the fate of the nation’s insurance markets and millions’ of Americans ability to afford or access health care released its new updated attack on the Affordable Health Care Act this morning. Initial reports are not encouraging.
For example, this tweetstorm by Andy Slavitt informs us that 22 million people will still lose health insurance due to the massive Medicaid cuts, which the new proposed bill retains:
Some additional early analyses are provided here and here. Or, as Ezra Klein succinctly observes:
After the last gang-of-12-rich-GOP-white-men-in-the-Senate version came out, Josh Marshall wrote the most insightful article I’ve seen analyzing the ideology behind the GOP’s approach to healthcare:
Ignore the headline of the piece, because its focus on journalism might lead you to conclude I posted the wrong thing or that the piece is not worth reading. I assure you, it is. Josh rightly takes on the poor reporting that over and over again obscures the real issues dividing the GOP from the Democrats on healthcare, and which has sets up a tired, false equivalence between the parties that perpetuates genuine falsehoods and a misunderstanding that the problem with health care legislation is an absence of bipartisan compromise.
The real problem is that a fundamental difference exists between the parties as to whether the government should have any role, at all, in health care (and, increasingly, the social safety net writ large). The people who control the GOP and the levers of government increasingly reject what used to be a genuine bipartisan consensus that the government does have a role to play in trying to eradicate poverty, limit income inequality, ensure that all citizens are eligible for a decent public education, help people (especially children) down on their luck in the form of food stamps and Medicaid and unemployment benefits, and make sure that people obtain health care and/or are not bankrupted by catastrophic illnesses/accidents:
Current Republican ideology, if not all Republicans, posits that it is simply not the responsibility or place of government, certainly not the federal government, to make sure everyone has health care coverage. You can agree or disagree with that premise. But it’s not hard to understand and it is not indefensible. Very few of us think the government should step in if someone doesn’t have enough money to buy a car. We don’t think there’s a right to a home or apartment where every child has their own bedroom. On most things we accept that things are not equal, even if we believe that extremes of inequality are bad for society and even immoral.
But many of us think that healthcare is fundamentally different. It’s not just another market product that we accept people can or can’t get or can or can’t get at certain levels of quality because of wealth, chance, exertion and all the other factors that go into wealth and income. This is both a moral and ideological premise.
Even Republican apologist David Brooks, albeit in his intellectually dishonest way, addressed this point by stating that conservatives (not the GOP leadership) have long accepted that government does have a responsibility to its citizens, but that the present GOP leadership disagrees. As Brooks explained,
Because Republicans have no national vision, they seem largely uninterested in the actual effects their legislation would have on the country at large. This Senate bill would be completely unworkable because anybody with half a brain would get insurance only when they got sick.
Worse, this bill takes all of the devastating trends afflicting the middle and working classes — all the instability, all the struggle and pain — and it makes them worse. As the C.B.O. indicated, the Senate plan would throw 22 million people off the insurance rolls. It would send them to private insurance plans that they could not afford to buy. Under the Senate bill, deductibles for poor families would be more than half of their annual income. The plans are so incompetently and cruelly designed that as the C.B.O. put it, “few low-income people would purchase any plan.”
This is not a conservative vision of American society. It’s a vision rendered cruel by its obliviousness.
Brooks also said that GOP think tanks have developed market based solutions, in contrast to Democrats. He’s right on the first half of that point, a liar by omission on the second — Obamacare is the conservative think tanks’ market-based solution to healthcare. Obama went for the marked-based approach over the Democrats’ true holy grail of single-payer/public option (reneging on a public option campaign promise) in order to try to get Republicans on board, thinking they would make nice with him given pre-Obama GOP support for the concept — after all, he was elected on a clear mandate of providing health care for Americans — because Obamacare is basically Romneycare at the federal level. In 2009–10, the Democratically-controlled Congress allowed for ten months of input from the GOP, along with debate and public hearings; the GOP offered gazillions of amendments, lied repeatedly to their supine constituencies that desperately needed end-of-care coverage was “death panels”, demonized the bill providing millions of Americans with health insurance as similar to slavery and equivalent to the Holocaust, and in the end voted against the Affordable Health Care Act, after it had been watered down to accommodate their many amendments, in lockstep.
As we know, McConnell, Ryan/Cantor, and the whole GOP flipped Obama and the country the bird because Making Sure the First Black President Fails was what they cared about, even if it meant the country sinking further into depression and millions losing their homes and thousands dying.
And the Democrats, true to fractious and self-cannibalizing form, didn’t defend their accomplishment, didn’t blanket the airwaves with refutations and talking points, and even to this day when they have the moral highground have ceded the messaging by allowing the Democrats’ vote in favor of the ACHA to be termed “partisan” (looking at you, Claire McCaskill). What the Democrats did was not partisan. Obama was elected with 54% of the vote after campaigning explicitly on the promise to deliver health care to more Americans. The absolute obstruction for obstruction’s sake, to tank a president, all one-way, all by the GOP, was partisan — despicably and cynically so.
But since that time, as Josh Marshall pointed out with great perception, the GOP has become completely locked in to opposing a government role in health care at all:
When you try three times to ‘repeal and replace’ and each time you come up with something that takes away coverage from almost everyone who got it under Obamacare, that’s not an accident or a goof. That is what you’re trying to do. ‘Repeal and replace’ was a slogan that made up for simple ‘repeal’ not being acceptable to a lot of people. But in reality, it’s still repeal. Claw back the taxes, claw back the coverage.
Pretending that both parties just have very different approaches to solving a commonly agreed upon problem is really just a lie. It’s not true. One side is looking for ways to increase the number of people who have real health insurance and thus reasonable access to health care and the other is trying to get the government out of the health care provision business with the inevitable result that the opposite will be the case.
So much of the coverage has been the GOP leadership attacking the Democrats, whom they have completely excluded from the process, for not “working” with them. Marshall’s observation makes clear that there is nothing to work with: the Democrats are willing and ready and able to work together to improve the Affordable Health Care Act; they are not, and should not be, willing to work with the GOP to dismantle this legislative achievement. As Marshall put it at the end of his piece:
If you had an old building and one group wanted to refurbish and preserve it and the other wanted to tear it down, it wouldn’t surprise you that the two groups couldn’t work together on a solution. It’s an either/or. You’re trying to do two fundamentally opposite things, diametrically opposed. There’s no basis for cooperation or compromise because the fundamental goal is different.
Interestingly, for the first time, today, Susan Collins has now rejected repeal and replace and opted for bipartisan improvements to Obamacare:
This decision is a specific and actual break with the current GOP leadership and orthodoxy. It is the first time since 2010, at least that I am aware of, that we are seeing a Republican acknowledge, however tacitly, that repeal is not the answer, that “replace” was a slogan and a lie, and that the Republican approach is indefensible, unworkable — and ought to be dead in the water.
