Nobody really disputes that health care in the US, in 2007, had some serious issues with both cost and access.
The Obama administration attempted to address this in a way that, with a sane opposition party, might product bipartisan support: they chose a plan actually authored by Republicans (the Heritage Foundation), and that had been used successfully at a state level by prominent Republican Mitt Romney.
This, in retrospect, as a terrible mistake, because the GOP of 2008 defined itself not by any principles, but by being opposed to literally anything Obama or the Democrats wanted to do. Consequently, the ACA — despite being an objectively conservative, market-based plan instead of a more liberal approach — came to be painted as a horrible liberal plot to destroy American health care (remember all the babble about “death panels?”). It didn’t matter to the GOP that it was a market-based approach that focused mostly on insurance market regulation; what mattered was that it had been achieved by the Democrats, and therefore it had to be destroyed.
That being the case, the Republicans have made repealing the ACA a key goal, notwithstanding the effects of said, and, again, not because of any policy reason, but simply because it was a Democratic achievement. They were safe in making these noises when a Democrat lived in 1600 Pennsylvania, because no such bill would get signed. They could get credit for fighting tyranny, or whatever they told their rabid base, without having to pay the piper. Now, they’re on the spot: they have the power, and a good chunk of their low-information base expects this evil Obamacare law to get repealed.
And so the GOP is preparing to repeal it wholesale, and without having an replacement on hand. Doing so will end coverage for millions of Americans, and will cost the Federal government no small amount of money. The GOP knows this, which is why they’ve taken steps to prevent the Congressional Budget Office from tallying any such cost overrun. From Fox News, of all places:
Part of the challenge lies in the potential cost of repeal. Estimates vary wildly on how much an ObamaCare repeal would add to the deficit. It hinges on who you talk to and what metric they use. Various figures range from $350 billion to $1 trillion to $9 trillion over a longer period.
But one thing is clear: Republicans already prepped a provision to ignore internal congressional budgetary rules if the repeal is successful and explodes the federal deficit.
Efforts to defang the House’s quasi-official ethics watchdog office scored most of the attention early this week as the GOP advanced a “rules” package to govern the body during this Congress. But Republicans tucked a provision into the plan which bars the Congressional Budget Office (CBO) from counting a dramatic spike in deficit spending spurred by an ObamaCare repeal. Language in the resolution bars the CBO from tallying the cost of any ObamaCare repeal bill that bloats deficit spending by more than $5 billion over the next decade and $20 billion over the next four decades.
And, again: that’s from Fox News, hardly an ACA cheerleader.
This is what happens when politics becomes a game and not a means of governance. Since Clinton, the GOP has been a party that cared far more about winning than they did about policy and the society those policies create. As Bill Kristol noted back during the Clintons’ foray into health care policy:
But the long-term political effects of a successful Clinton health care bill will be even worse–much worse. It will relegitimize middle-class dependence for “security” on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
Even 25 years ago, opposition to Democratic efforts on health care policy was positioned as game strategy, not as what was best for the country. This is because the Republican party has long since abandoned any pursuit other than perpetuating the Republican party.
Republicans clearly do not give one single damn about medical bankruptcy, or lack of coverage, or the shrinking middle class that is increasingly vulnerable to these problems. They are no longer a party of policies and ideas. In my life, the Republicans have mostly been the party of Fear. Fear the Russians, sure, but when the Cold War ended, they had a hard time finding something else to make us afraid of for a little while before deciding the right targets were minorities. Fear the gays. Fear the immigrants. Fear the muslims. Fear the transgender boogeymen hiding in the rest room to molest your daughters. There are no meaningful Republican policy proposals for the problems of medical bankruptcy, or lack of coverage, or for how the increasingly struggling middle class should handle high premiums and pre-existing conditions. (ProTIP: A HSA isn’t gonna help much when you earn $50K a year and need $200,000 worth of care.)
There are no great Republican proposals for how to address the increasing gap between rich and poor, in part because the Republicans seem to love everything about the 1950s except the tax rates, which they’ve been hammering downward for decades despite obvious signs that this is a very, very bad idea (see: deficit; infrastructure spending; state of education in the US; state of health care in the US).
What we get instead are policies pursued to please a right-wing base no matter the cost (like the ongoing assault on Planned Parenthood, which has produced a measurable uptick in infant mortality), or policies designed to inflame that base and vote (for example, bathroom bills), with utterly no regard for the real world effects. Our soon-to-be vice president, Mike Pence, has his own home-state version of this problem, as his resistance to needle-exchange programs in Indiana literally created an HIV explosion.
Republicans do not care about food insecurity in the US; instead, we get bills that insist on drug tests for welfare recipients (it will surprise no one to discover that there are almost zero positive tests in states with such laws, which as a bonus cost a whole bunch of money).
Republican solutions to homelessness involve busing them to other towns.
When asked about these problems, Republicans — like Kristol back in 1992 — wave their hands and mutter about tax credits and markets, but there will never and can never be a market-based approach to health care that covers everyone (or education, for that matter). And the older I get, the harder it is for me to believe that anyone outside of 18-year-old proto-Objectivists actually believe that a full market based policy system would actually work. I think they just don’t care what happens to the people who don’t end up on top.
And, as it turns out, enough voters agree — though not, of course, most of the voters — that we’ll get to see what happens when they get control, starting later this month.
(N.B. that none of this is about Trump. He’s a whole OTHER problem; this post is about the party, not the absurd candidate they embraced.)