By David Harsanyi
Monday, June 26, 2017
In a piece in the Washington
Post today, EJ Dionne allegedly lays out the “three big lies about health
care.” It nicely encapsulates many of the Democrats’ political arguments
against repeal (though unlike many of his allies, Dionne was kind enough to
refrain from accusing Republicans of manslaughter in this column.) One of them,
however, isn’t a lie at all. The other is a debatable policy question, and the
third is an absolute strawman.
“Lie One: Democrats
and progressives are unwilling to work with Republicans and conservatives on
this issue.” Dionne actually writes the following sentence: “In fact,
Democrats, including President Barack Obama when he was in office, have said
repeatedly that they would like to work with Republicans to improve the
Affordable Care Act.”
Oh, is that what Obama said?
First off, let’s talk about the absurdity of this
framing, which drives a lot of coverage. It is odd, to say the least, that even
after years of wide-ranging historic wins—many of them driven by an explicit
promise to repeal Obamacare—Republicans are still the ones asked to work with
Democrats “to improve the Affordable Care Act.” That isn’t the issue. The
question is: why don’t Democrats have to work with Republicans to find the best
way dismantle Obamacare? This is the topic democracy has laid on the table.
Because as Obama might say, “they won.” And won. And won.
Second off, the passing of Obamacare—even more than the
policy consequences of the bill—not only decimated the Democratic Party but
frayed our contemporary political order. The chances of any truly bipartisan
major reform in the foreseeable future is nonexistent. Democrats were willing
to push through major national restructuring of a massive chunk of the American
economy without any buy-in from half the country. They created a new norm. So
while no one is expecting liberals to help unravel Obama’s signature
legislation, the idea that Republicans should be expected to save it is weak.
It is true that Obamacare would likely die without
Republican help. “But those ‘circumstances,’” claims Dionne, “have been created
by the GOP itself. A completely different coalition is available, but
Republicans don’t want to activate it because they are hellbent on repealing
Obamacare. Why?”
Democrats, who ignored
the Constitution when it came to subsidy payments and ignored basic
economics when it came to state exchanges, have only themselves to blame for
writing a bad bill. Long before Donald Trump ever became president, insurance
companies were fleeing state exchanges. Long before Donald Trump was president,
premiums were increasing and choices were constricting.
Perhaps the ACA debate was a reflection of a coming
national split, or perhaps it was partly the cause. Whatever the case, it is
revisionism to claim that Democrats were interested in conservative ideas (and
please spare me the individual mandate myth). The supposed liberal concessions
were based on pretend hearings and meaningless feel-good letters. In truth, the
only compromises that went on in earnest were between liberals who were worried
about capturing the votes needed to pass any bill, and moderate Democrats who
were worried that their careers would be destroyed. Both of these things would
come to fruition.
“Lie Two: This bill
is primarily about improving health care for American families. No, this effort
is primarily about cutting taxes.” Now, it’s plausible that EJ Dionne can
bore into the souls of everyone involved in the bill, but whatever you make of
the Senate’s initial (moderate) proposal, and many conservatives hate it, it’s
about a lot more than tax cuts. When Democrats lean heavily on their go-to
platitude about tax cuts for the rich, it undermines the notion that they’re
serious about negotiating on anything.
Moreover, there is nothing in Obamacare that “improves
health care” for “American families” (it’s like reading ad copy.) ACA was
mostly about expanding coverage, not improving care—though Obamacare’s
expectations and purpose have been dramatically reimagined since 2010 to create
imaginary success. If we evaluate ACA using the parameters Democrats themselves
laid out when campaigning and passing, it has failed on everything other than
the massive expansion of welfare. Even then, it offers “access” by threatening
and forcing people to buy insurance. This is tantamount to celebrating an increase
in military recruitment after passing a draft.
“Lie Three: The
Senate bill is a ‘compromise.’” Dionne doesn’t offer a single example of
any Republicans saying that their bill is compromise with Democrats, nor could
I find one such example. So perhaps it exists, but certainly isn’t a
predominant talking point. It is a compromise in the same way that Obamacare
was: between wings of the same party. The only difference is that the 2017 GOP
is bothering to pretend otherwise.
In Dionne’s defense, he does provide one big obvious
fiction when admonishing moderate Republican senators not to vote for the GOP
bill:
Do they really want to say someday
that one of their most important votes in the Senate involved taking health
care away from millions of Americans? I would like to believe they are too
decent for that. I hope I’m not lying to myself.”
I think you are. Whatever you make of the Republican
efforts to un-knot Obamacare’s state-driven control of healthcare insurance
markets, none of their plans take health care away from a single American. What
AHCA might get rid of is the individual mandate, which will end the
unprecedented policy of forcing American consumer to buy things they don’t
want. And they may—color me skeptical—follow through on rolling back future
spending on Obamacare’s Medicaid expansion. Don’t worry, though: despite what
you may hear about the end of Medicaid, it will still be, by far, one of the
biggest items in the U.S. budget.
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