Why Democrats shouldn't be too giddy about the GOP's health-care disaster
Democrats just won a big health-care battle. But the war is still on.
Make no mistake: The GOP yanking its plan to repeal and replace the Affordable Care Act to preempt its inevitable defeat in the House of Representatives is a yoooge win for the Democratic Party and the American people, and a humiliating defeat for the Republican Party.
But it's still just one win in a much bigger fight.
The most important thing about the defeat of the American Health Care Act is that the major gains that ObamaCare has made in expanding insurance coverage will mostly remain in place. But it's also worth asking why the plan failed and what it means going forward. It's a defeat that reveals real tensions and weaknesses within the Republican Party. But that doesn't mean that the GOP is doomed either.
Many of the juicy postmortems have focused on failures of leadership on the part of President Trump and Speaker Paul Ryan. And, indeed, both seem in over their heads in ways that will complicate passing the Republican agenda going forward. Ryan's alleged mastery of policy was revealed as a complete fraud, and Trump's various efforts to persuade recalcitrant lawmakers were ineffective. But it's extremely unlikely that even stronger leadership could have gotten a replacement for the ACA passed. The votes were never going to be there.
The reason the votes weren't there is simple: The proposed legislation was unimaginably terrible. And this isn't just because it was a hastily cobbled together mess that even wonks sympathetic to conservative health-care ends generally wouldn't defend. The central problem is that taking health insurance away from more than 20 million people and making insurance worse and/or more expensive for those who retain it in order to pay for a massive upper-class tax cut is an idea with no popular constituency. To pass a statute that would directly affect the lives of many voters and was supported by less than 20 percent of the public would have been political suicide.
As University of California political scientist Paul Pierson has shown with extensive evidence, repealing major social programs is enormously difficult, even in political systems with fewer barriers to changing the status quo than the American one. The weak Republican leadership didn't help, but particularly given the relatively small Republican House majority and the even narrower margin they had in the Senate, the AHCA was probably always destined to be stillborn.
This should give liberals a new appreciation for what Barack Obama, Nancy Pelosi, and Harry Reid were able to achieve when they passed the Affordable Care Act in 2010. Democrats needed the vote of each and every one of their 60 senators. That meant Reid and Obama needed the support of more than a dozen moderate Democratic senators from red states. But they also needed the plan to maintain support from liberal senators who were well aware that the ACA fell short of the universal systems common to other liberal democracies (even though it was a substantial improvement on the status quo). Last week's GOP debacle is an excellent illustration of how quickly attempted compromises can unravel from both ends. Both the left and right of the Democratic caucus deserve a great deal of credit for holding together under intense pressure to give up in 2010.
This accomplishment will remain on the books for the foreseeable future. But what does the collapse of the attempt to repeal it mean going forward?
From a Democratic standpoint, the optimistic take would be that this trainwreck represents a GOP coalition in its death throes. Just as the repeated failures of the Democratic Party to reach a consensus and enact its agenda under Jimmy Carter signaled the collapse of the New Deal/Great Society coalition, the failure of Trump and Ryan to execute what has been a rallying cry for Republicans for seven years could signal the cracking up of the Reagan coalition.
This is certainly possible. But I think reading a major realignment into the failure of RyanCare would be premature. I think it's more likely that, despite this failure, the Reagan coalition will remain resilient. Comprehensive health-care reform has always been extraordinarily difficult. Harry Truman's proposal for national health insurance never got off the ground, but this didn't mean the New Deal coalition was dead. The failure of Bill Clinton's health-care plan, which was similar in some ways to the failure of the AHCA, although the process was much more serious and protracted, did not end the liberal aspiration to attain universal health care. And given the extent to which both Congress and state legislatures are structurally titled in favor of the Republican Party, they have little incentive to moderate despite this failure.
The Democrats just won a major battle. But the war is still on.
And we shouldn't forget what the Republican Party has revealed about itself. Most of its members, including its House leader, believe that many people who can't afford health insurance should simply be left to suffer. They weren't able to get rid of the ACA, but Republicans can still hamper it administratively, through the courts, and at the state level. And they will work furiously to stop the movement to use the ACA as a basis to move toward truly universal health care.
Friday's victory is a reason for progressives to celebrate, but certainly not to be complacent.