The Senate’s Republicans unveiled their plan for America’s health care on Thursday, and although it’s an admirably short 142 pages there’s a lot consider about the policy and political implications. As President Donald Trump once infamously said, “Who knew health care could be so complicated?”
The policy implications alone will take weeks of debate among people who actually have some idea what they’re talking about to sort out, but the previously unannounced bill is currently scheduled for a vote early next week. So far as we can tell from the news reports that concern themselves with the boring policy stuff, the Senate Republicans’ repeal and replaces some elements of the existing unpopular Obamacare law, differs somewhat from the even more unpopular bill that was passed by the House of Representatives’ Republicans, and will predictably leave some people better off and others worse off. Calculating how likely it is that this all comes out according to the greatest good to the greatest number of people is pretty damned complicated, as even the most greenhorn politician by now knows, and it looks as if we’ll just have to wait until we’re old and sick and to see how all that turns out,
We like to think ourselves far more savvy about the political implications of any given policy, but in this case that’s also pretty darned complicated. That unpopular Obamacare law has been the metaphorical Moby Dick to the Republicans’ Captain Ahab ever since the Democrats took momentary advantage of Democratic majorities in the House and Senate and a Democratic president to force the hated legislation down the throats of a reluctant American populace without a single Republican vote. Now there’s a momentary majority of Republicans in the House and Senate and a Republican in the White, so that unpopular Obamacare should be right in the aim of the Republicans’ harpoon, but it’s unlikely they’ll join to pass and unpopular bill of their own.
So far as we can tell both the House and Senate bills allow people to choose a wider range of policy options from a more competitive insurance market, and after a couple of years they’ll let the rest of the country free from paying the subsidies to government-created high risk markets, which is fine with our free-market sensibilities. After that, though, hey’ll also cut loose the beneficiaries of those markets, some of whom voted a straight Republican ticket last time around, and we’re not sure hot they’ll take it.. Planned Parenthood won’t receive any funds for a year, which the right will love and the left will loathe, and certain insurance industry subsidies will continue for a while and a lot of spending will eventually be spent at the state level, and there’s something for every conservative Republican to hate and something that every liberal Democrat will have to admit could have been worse.
Which makes it a tough news cycle for the Republicans. As hated as the Obamacare still is, and well deserves to be, the Republican alternatives from both the House and Senate have even more unpopular. The House bill results in a tax break for wealthier Americans, which might make economic sense but is hard to explain in a headline, and there’s no getting around that some telegenically sympathetic Americans would wind up without health care and on national news as a result, so it will take a pretty noticeable decline in a lot of Americans’ insurance premiums to offset the Republicans’ public relations damage. Both the House and Senate bills retain the unsustainable rules about giving the same priced coverage to pre-existing conditions and for now provide the billions of dollars of subsidies that props that up, but no one on the left is going to give the Republicans credit for that nor acknowledge how unsustainable that will be over is the long run.
There’s a lot for an old-fashioned Republican to like in both the House and Senate bills, but there’s enough to hate that the House bill passed by despite numerous defections and the Senate bill might not get to a simple majority, and all the talk radio hosts were fuming that it wasn’t the full repeal and replacement of Obamacare that they’d been chasing after for eight long years. We’d have to see some district-level polling to decide how we’d vote if we were one of the entire House or that third of the Senate was up re-election. What with those Republican majorities in both the House and the Senate and a Republican in White House the Republicans should be able to ram anything they want down the American public’s throats in the same way the Democrats did with that damned Obamacare law, but of course that’s also complicated.
Trump ran for the president on a solemn pledge to repeal and a replacement that hated Obamacare law, but except for assurances that it would provide coverage for everyone at a far lower cost and be so great it would make your head spin he wasn’t very clear on what it would look. He spoke admiringly of Scotland’s fully nationalized health care system, seemed to endorse Canada’s slightly-less-socialized single payer system, and bragged that unlike every other Republican he wouldn’t make any cuts in in Medicaid or other entitlement programs. Unlike the previous scenario when Democratic majorities in the House and Senate and a president in the White House were ramming things down the American public’s throat, a sufficient number of traditionally conservative Republican senators are taking a principled stand and the president is going his populist ways.
Trump celebrated the passage of the House bill with a beer bash at the White House, even though he’s a tee-totaler himself and the House passing a bill isn’t even a halfway marker toward getting something done. After that budget-cutting bill was celebrated he “tweeted” that more federal money should be spent on health, and it was leaked from pretty much every traditional conservative that Trump had called the House bill “mean” in a tense meeting with the House Republicans, and it’s not yet clear how he’ll respond to a similar Republican bill,
On the night before the Senate Republicans unveiled their health care bill Trump was revving another enthusiastic campaign rally, some eight months after the campaign was supposed to have ended, Trump said he was hopeful would that it would have “heart.” A news cycle isn’t nearly long to discern Trump’s thinking, so for now we’ll have to see if the legislation as sufficient heart to satisfy Trump. All of Trump’s most strident defenders on talk radio and other outposts of the conservative media find it all too bleeding-heart, many of his voters find it potentially life-threatening, and we can only guess where Trump will wind up. We can’t imagine the Democrats seizing this golden opportunity to kiss up to Trump for that single payer system they’ve always dreamed of, or Trump abandoning that portion of the Republican party that’s all he’s got left at the moment, so we expect some desultory compromise on America’s health care.
We’ll hope that it somehow works out with that greatest good for the greatest number, and given how awful that Obamacare law was we wouldn’t be the least bit surprised if something better did somehow come to pass.
— Bud Norman