Why everyone hates the GOP's new health plan
It's extraordinary what a hash the Republican Party has made of repealing and replacing ObamaCare
Just how pathetic is the contemporary Republican Party?
So pathetic that it voted dozens of times to repeal the Affordable Care Act without having any coherent idea of, or consensus about, what it wanted to pass as an alternative (despite repeated claims to the contrary).
So pathetic that it committed itself to passing a replacement bill on an arbitrary deadline that ensured the end result would be filled with flaws that experts on its own side could identify within a few hours.
So pathetic that it appears not to have realized that an army of conservative activists and right-wing health-care wonks, along with a bevy of Republican politicians, would respond to the American Health Care Act with open disdain.
So pathetic that some liberal commentators have speculated (in a half-serious way) that House Speaker Paul Ryan must have intended for the AHCA to go down in flames, since he couldn't possibly be inept enough to oversee such a debacle of a rollout. (For the record, I don't think Ryan is anywhere close to being clever enough to pull off something of that scope.)
On health care, Republicans know one thing: They despise the ACA with a blinding fury. But beyond that, they have no idea what to do.
How do we know that? Because the AHCA is a sloppy, muddled mess of a bill that's seemingly designed to please no one, except for rich people who want their taxes lowered. (In which case it's hard to understand why the House didn't simply pass a deficit-financed tax cut for upper income families and leave the ACA alone.)
Aside from the perfunctory tax cut, there's really nothing in the bill to satisfy the desires of the hardcore libertarian faction of the GOP that very clearly does know what it wants — namely, a "free market" system of health care for everything except bare-minimum catastrophic coverage. That's been the notional goal of Republican reformers at least since the ACA passed in 2010.
The only problem is that the transition to a more market-based system would inflict enormous pain on many millions of Americans who carry forms of insurance that are made available and affordable by the heavily regulated and subsidized system we currently have. Now, some of the Ayn Rand-quoting libertarian true believers who make up the House Freedom Caucus would undoubtedly vote for a such a bill, no matter how much suffering it imposed. Ideologues are like that. But most politicians are far too self-interested to willingly die for a cause.
And so we have the bill unveiled Monday, which, as several commentators on the right have pointed out, keeps the general architecture and assumptions underlying ObamaCare intact while merely fiddling with a lot of the details. Don't get me wrong: Those adjustments will likely hurt plenty of people, though probably a lot fewer than a switch to a genuine market-based approach would have done. But it's hard to estimate precisely what the AHCA's real-world costs or fiscal effects might be because Ryan has decided to move ahead with marking up the bill without first getting it scored by the Congressional Budget Office.
So this is where the Republicans find themselves: trying to pass a bill that's unpopular with the right for compromising too much with ObamaCare and unpopular with moderates for inflicting too much pain on voters. And they're doing all of this while groping around in the dark because Ryan wants to keep the CBO out of the loop (no doubt partly out of fear of provoking even more opposition — from the party's deficit hawks, for example).
It's a mess — and a completely self-inflicted one.
And that's without even mentioning the extra-large serving of Republican mess that is Donald Trump.
The president described the bill as "wonderful" in a tweet, but he can't possibly be happy with how the rollout has unfolded so far. That's not just because he craves praise and bridles at bad press. It's also because, in the scheme of the contemporary Republican Party, Trump is a radical leftist when it comes to health-care policy.
One reason many rank-and-file Republicans and conservative-movement intellectuals originally denounced Trump as a closet liberal is that he once supported a single-payer system — an option so far out in the direction of outright socialism that even Barack Obama and his Democratic majorities didn't dare seriously consider it back in 2009. Trump doesn't explicitly advocate such a radical reform today, but he alone among leading Republicans still talks in terms of providing "insurance for everybody." Trump and the Freedom Caucus may agree, for utterly mysterious reasons, that ObamaCare is an unmitigated "disaster," but they agree about very little else. Bridging that gap may well prove impossible.
The really interesting question is what Trump will do if the AHCA collapses (as it already appears likely to do). Will he encourage the writing of and play a bigger role in drafting a new "replacement" bill that cuts coverage for millions of Americans? Or will he turn on Ryan and much of the rest of his party, demanding that they scrap ObamaCare, not for a free-market utopia but for a single-payer system that provides open access to health care for all Americans?
Such a move would likely tear the GOP apart, while gaining Trump many surprising new allies in the Bernie Sanders wing of the Democratic Party.
Will it happen? When a party becomes as incoherent as the Republican Party is today, anything is possible.