In “The Republican Health Care Crackup” Bobo says it’s not just a bill, it’s the end of an era in American politics. “Larry Hedrick” from DC will have something to say to Bobo. Prof. Krugman has questions in “A Bill So Bad It’s Awesome:” What were Republicans thinking? Were they even thinking? Here’s Bobo:
The Republican health care bill could represent the moment when the old order of American politics completely cracks up, the end of a certain era in American politics.
That era began around 1974, when Ted Kennedy introduced a bill to supplement America’s employer-based insurance system with a government program. The Democratic dream of universal coverage continued through Hillary Clinton’s time as first lady and reached a partial culmination with the passage of Obamacare.
Combating government health care was a central Republican preoccupation through all that time, and the passage of Obamacare provoked the Tea Party reaction and final arrival of Goldwaterite populist conservatism.
By 2010, however, both the Obama administration and the Tea Party opposition were out of step with the times. They both still thought the big political issues in American life were universal health care and the size of government.
In fact, another set of problems had magnified and come to overshadow the old set. This new set included:
First, the crisis of opportunity. People with fewer skills were seeing their wages stagnate, the labor markets evaporate. Second, the crisis of solidarity. The social fabric, especially for those without a college degree, was disintegrating — marriage rates plummeting, opiate abuse rates rising. Third, the crisis of authority. Distrust in major institutions crossed some sort of threshold. People had so lost trust in government, the media, the leadership class in general, that they were willing to abandon truth and decorum and embrace authoritarian thuggery to blow it all up.
If President Obama had made these crises the center of his administration, instead of the A.C.A., Democrats wouldn’t have lost Congress and the White House. If the Tea Party had understood the first two of these crises, there would have been no opening for Donald Trump.
Trump came along and exploited these crises. But if his administration’s health care approach teaches us anything, it is that he has no positive agenda for addressing them. He can tap into working class anxiety negatively, by harnessing hostility toward immigrants, foreigners and the poor. But he can’t come up with a positive agenda to make working class life more secure.
So we have a group of Freedom Caucus Republicans who still think the major problems in the country today can be cured with tax and spending cuts. We have a Trump administration that has populist impulses but no actual populist safety net policies. And we’ve got a Republican leadership in Congress mired in Reagan-era thinking and trying to pay lip service to every obsolete prejudice in the various wings of the party.
You end up with this hodgepodge legislation that pleases nobody and takes the big crises afflicting our country and makes them all worse.
The Republican health plan would make America’s economic chasm worse. It would cut health subsidies that go to the poor while eliminating the net investment income tax, which benefits only the top 1 percent.
The Republican plan would further destabilize the social fabric for those at the bottom. Throwing perhaps 10 million people off the insurance rolls will increase fear, isolation, social tension, chronic illness, suicide and bankruptcy.
The Republican plan will fuel cynicism. It’s being pushed through in an elitist, anti-democratic, middle of the night rush. It seems purposely designed to fail. The penalties for those who don’t purchase insurance are so low they seem sure to guarantee Republican-caused death spirals in the weaker markets.
This thing probably won’t pass, but even if it passes it will probably lead to immense pain and disruption. That will discredit market-based social reform, cost the Republicans their congressional majorities and end what’s left of the Reagan-era party.
It will also point the way to a new era.
The central debate in the old era was big government versus small government, the market versus the state. But now you’ve got millions of people growing up in social and cultural chaos and not getting the skills they need to thrive in a technological society. This is not a problem you can solve with tax cuts.
And if you don’t solve this problem, voters around the world have demonstrated that they’re quite willing to destroy market mechanisms to get the security they crave. They will trash free trade, cut legal skilled immigration, attack modern finance and choose state-run corporatism over dynamic free market capitalism.
The core of the new era is this: If you want to preserve the market, you have to have a strong state that enables people to thrive in it. If you are pro-market, you have to be pro-state. You can come up with innovative ways to deliver state services, like affordable health care, but you can’t just leave people on their own. The social fabric, the safety net and the human capital sources just aren’t strong enough.
New social crises transform party philosophies. We’re in the middle of a transformation. But to get there we’ve got to live through this final health care debacle first.
Now here’s what “Larry Hedrick” from DC had to say about that:
“Mr. Brooks thinks it’s necessary to write that the Republican destruction of Obamacare will ‘fuel cynicism.’ As though it shouldn’t?
As for the Republican alternative (I use the word loosely) being ‘purposely designed to fail,’ I can’t see that it’s ‘purposely designed’ to either succeed or fail.
The only thing it’s designed to do is to shift more wealth from poorer people to richer people.
Beyond that, Republicans don’t care–which is why they’ve done such a sloppy job of creating this new self-contradictory jumble of words that they’re pleased to call a law.
I suppose it’s needful to review the basics just one more time.
David, the GOP to which you’ve devoted so much of your life has long been nothing more than an open conspiracy of the rich against the poor. That’s its sole purpose, beyond existing to feed its own bureaucracy.
Republican politicians are nothing more or less than hacks who are paid to keep the money flowing uphill while they clutter up the minds of the people with empty promises of perfecting the American commonwealth.
In Trump they’ve found their true champion, because he’s put them on the royal road to authoritarianism. It is in this darkness, which the pr*sident deepens with every lying tweet, that democracy dies.”
Now here’s Prof. Krugman:
It has long been obvious to anyone following health policy that Republicans would never devise a workable replacement for Obamacare. But the bill unveiled this week is worse than even the cynics expected; its awfulness is almost surreal. And the process by which it came to be tells you a lot about the state of the G.O.P.
Given the rhetoric Republicans have used over the past seven years to attack health reform, you might have expected them to do away with the whole structure of the Affordable Care Act — deregulate, de-subsidize and let the magic of the free market do its thing. This would have been devastating for the 20 million Americans who gained coverage thanks to the act, but at least it would have been ideologically consistent.
But Republican leaders weren’t willing to bite that bullet. What they came up with instead was a dog’s breakfast that conservatives are, with some justice, calling Obamacare 2.0. But a better designation would be Obamacare 0.5, because it’s a half-baked plan that accepts the logic and broad outline of the Affordable Care Act while catastrophically weakening key provisions. If enacted, the bill would almost surely lead to a death spiral of soaring premiums and collapsing coverage. Which makes you wonder, what’s the point?
Obamacare rests on three main pillars. Insurance companies are regulated, prevented from denying coverage or charging higher prices to Americans with pre-existing conditions. Families receive subsidies linked to both income and premiums, to help them buy insurance. And there is a penalty for those who don’t buy insurance, to induce people to sign up even if they’re currently healthy.
Trumpcare — the White House insists that we not call it that, which means that we must — preserves some version of all three elements, but in drastically, probably fatally weakened form.
Insurers are still barred from excluding the sick, but they’re allowed to charge older Americans — who need insurance the most — much higher premiums.
Subsidies are still there, in the form of tax credits, but they’re no longer linked to either income (as long as it’s below $75,000) or the cost of insurance.
And the tax on those who don’t sign up becomes a small surcharge — paid to insurance companies, not the public — on people who sign up after previously letting coverage lapse.
Affluent young people might end up saving some money as a result of these changes. But the effect on those who are older and less affluent would be devastating. AARP has done the math: a 55-year-old making $25,000 a year would end up paying $3,600 a year more for coverage; that rises to $8,400 for a 64-year-old making $15,000 a year. And that’s before the death spiral.
For the combination of price hikes and weakened penalties would lead many healthy Americans to forego insurance. This would worsen the risk pool, causing premiums to rise sharply — and remember, subsidies would no longer adjust to offset this rise. The result would be even more people dropping out. Republicans have been claiming that Obamacare is collapsing, which isn’t true. But Trumpcare, if implemented, would collapse in a Mar-a-Lago minute.
How could House Republicans under the leadership of Paul Ryan, who the media keeps assuring us is a smart, serious policy wonk, have produced such a monstrosity? Two reasons.
First, the G.O.P.’s policy-making and policy analysis capacity has been downgraded to the point of worthlessness. There are real conservative policy experts, but the party doesn’t want them, perhaps because their very competence makes them ideologically unreliable — a proposition illustrated by the rush to enact this bill before the nonpartisan Congressional Budget Office can estimate either its costs or its effects. Basically, facts and serious analysis are the modern right’s enemies; policy is left to hacks who can’t get even the simplest things right.
Second, Republicans seem to have been undone by their reverse-Robin-Hood urges. You can’t make something like Obamacare work without giving lower-income families enough support that insurance becomes affordable. But the modern G.O.P. always wants to comfort the comfortable and afflict the afflicted; so the bill ends up throwing away the taxes on the rich that help pay for subsidies, and redirects the subsidies themselves away from those who need them to those who don’t.
Given the sick joke of a health plan, you might ask what happened to all those proclamations that Obamacare was a terrible, no good system that Republicans would immediately replace with something far better — not to mention Donald Trump’s promises of “insurance for everybody” and “great health care.”
But the answer, of course, is that they were all lying, all along — and they still are. On this, at least, Republican unity remains impressively intact.