The Health Care Clusterfuck the Republicans Are in Right Now
Whatever Republicans do on health care, they are seriously screwed
Welcome to Thanksgiving week. In spite of the terrible things Trump keeps doing and saying, Democrats and progressive-minded Americans have much to be thankful for. Republicans not so much. One issue they are deeply screwed on is health care.
The reason that Donald Trump keeps signaling that he is about to come up with a new health care plan and then fails to deliver one is that every single Republican option on health care is a massive loser with the American public, and unlike on many other policy issues, voters really pay attention to the details on health care.
A little history
Back in the 1990s, several eons ago, there was a moderate wing of the Republican Party, and on the health care issue, Republicans actually had serious policy ideas to contribute to the debate. The leading Republican on health policy in the Senate, John Chaffee, introduced a bill providing for universal coverage in 1993 that had 22 Senate Republican co-sponsors.
The theory at the time was that the Clinton administration would introduce their version of health care reform, and then the Republicans would come to the table with the Chaffee bill and we would forge a compromise. However, there was a political decision made by Newt Gingrich that Republicans should vehemently oppose health care reform because any new health care bill passed would become as beloved as Social Security, the GI BIll, and Medicare, and would help Democrats in their future political battles for decades to come. The Republicans and the health insurance industry defeated “Hillarycare”, as they called it. Democrats, disappointed by the health care disaster and the passage of NAFTA, failed to turn out in big numbers in the 1994 election, and Republicans swept into power in both houses in Congress.
Short term, that strategy obviously worked great for them, as did their identical decision in 2009-10 to oppose what was essentially that same Republican bill, which was pretty much the basis for the ACA. Their demonization of the ACA helped them win the 2010 election in a landslide.
Ever since, though, it has put them into the exact political box that Gingrich had predicted in 1994 - voters like having more help with health care benefits. When Trump tried to repeal the ACA in 2017, the backlash was fierce and the issue hurt them badly in both 2018 and 2020.
The political and policy problem
Fast forward to today. The political problem for Trump and the Republicans on health care isn’t just the fear that voters have in terms of their benefits being taken away. The even bigger problem for them is what the hell to propose as an alternative. The thing I learned from working on health care with Hillary all those years ago is that every change you make in the health care system creates complications, and voters pay a great deal of attention to the details of health care policy because it is such a big part of their lives. For Republicans, the problem is exacerbated by a factor of about 10 because what they want to do to save money and move the health care system more in a free market direction will screw millions of people over badly.
All of their policy ideas will result in some combination of higher insurance rates and prescription drug costs for more people, fewer people being covered, more sick people being thrown off insurance plans, and more hospitals being closed. The only people “empowered” by their free market proposals are insurance and pharmaceutical CEOs.
Republican options
Trump and his Republican allies in Congress basically have three options:
Put out a policy proposal that will deeply piss people off.
Do what Trump has been doing for a decade now, which is to keep putting off announcing a health care policy proposal, and do nothing. With subsidies going away and premiums skyrocketing, that too will deeply piss people off.
Cave in to Democratic demands to extend the health insurance subsidies. That will make them look weak and dumb, and will piss their health industry donors, but it will at last make voters happy.
Republican leadership in Congress or the White House have not produced a health care proposal since 1993. They have walked into a clusterfuck of their own making this year when they ended those health care subsidies and cut Medicaid so deeply. None of those political alternatives work for them.
One more thing to be thankful for this week. Enjoy your holiday.
Mike, such a great and artfully stated Thanksgiving post. I will send it around.
I’m proud to have spent a bunch of our lives, together, pushing for health care reforms. As you say, people want them!