Republicans Cannot ‘Solve’ Health Care In Good Faith

Fiscal conservatism defines nearly all Republicans, even if decades of failed economic promises say otherwise, but the modern Republican Party is also a collective of combative factions. There are extreme social conservatives who often vote based on social wedge issues like abortion. There are moderate social conservatives who tend to go along with many social conservative positions, but who are primarily fiscal hawks. And there are extreme fiscal hawks who lean libertarian, and in many cases reject some of the more offensive tenets of social conservatism.

But there is a fourth hybrid faction. This faction of white working-class voters cuts across all other factions. These are people who didn’t merely vote for Donald Trump, they showered him with raucous support and adoration. Members of this faction might self-identify as fiscally conservative, but nonetheless they can be influenced by the right populist message. After all, they voted for a man who vowed to repeal the Affordable Care Act (Obamacare) and replace it with something better, something he promised would cover more people.

Somewhere in this disarray, congressional Republicans must find a way to carve out an Obamacare replacement bill satisfactory to all factions. It is especially a challenge because Republicans only have a 2-seat majority in the Senate.

The task of reconciling the differences between the warring factions appears futile. But even if Republicans manage to cobble together a bill that satisfies enough GOP members to guarantee passage, the Republican Party will never in good faith solve health care in America. They might pass a new health care bill, but don’t for a second mistake it as anything more than a mirage. That’s because the Republican Party has never been interested in the idea of universal health care coverage. It doesn’t align with their small government, less tax philosophy. However, they aren’t stupid. They know they need to do something. They can’t just repeal Obamacare and call it a day.

But Republicans must also know any earnest attempt to expand insurance coverage to more Americans, must include a recognition that the only way you pay for this is by taxing the wealthy to subsidize the poor. And Republicans probably also know healthy Americans and unhealthy Americans must exist in the same insurance pool to avoid astronomical premium costs to those who are sick. Republicans ought to know a working health care insurance pool is a pool of greatest possible diversity, something like, say, “Medicare for all.” They must know all of this, right? But to acknowledge these things as truths would cause a cognitive dissonance so painful, they will seek any means, no matter how extreme, just to make it stop.

So it seems their chosen remedy is to inflict more health care suffering on the American public, something they are calling the American Health Care Act. It keeps the popular ACA provisions like not denying coverage for pre-existing conditions, and coverage up to age 26 on a parent’s plan. And while it initially keeps Medicaid expansion in place (currently covering about 11 million Americans), that funding will reduce in 2020 and beyond, leading to an eventual phase out. Subsidies to buy health care insurance become more stingy. And the ACA’s individual mandate, which requires Americans to have health care insurance or pay a fine, would be replaced with a 30 percent surcharge on Americans who buy insurance after letting their previous coverage lapse. Oh, and the GOP bill would also defund Planned Parenthood. Those last two are pure Republican contempt.

Why do Republicans insist on doing these things when they must know it will lead to fewer people having insurance coverage? It’s not because “we” can’t afford it. The ACA in-part paid for Medicaid expansion by increasing taxes on high-income earners. The GOP plan would roll back those taxes. In other words, Republicans say we can’t afford Medicaid expansion because they need to give the wealthy a multi-hundred billion dollar tax cut over the next decade. It could be said that the American Healthcare Act is not much more than a few carry-over ACA regulations attached to a tax cut for the rich.

There is nothing better about the Republican plan, and it assuredly will not extend health insurance coverage to more Americans. Like I said before, there is good reason the Republican Party has never attempted to pass a comprehensive health care law. Simply said, it is not something they believe in.

Maybe that’s why the list of groups opposing the GOP plan continues to grow, a list now including AARP, the American Medical Association, the American Nurses Association, the American Hospital Association, the Association of American Medical Colleges, the Catholic Health Association of the United States, and the Children’s Hospital Association.

If Republican orthodoxy is good at anything, it is smothering pragmatism with an air of conceit.

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