Health Care Addendum

As a short addendum to what I have been saying recently about health care and the Republican efforts to ‘reform’ it I want to add the following:

1. One of the major obstacles the Republicans face is that Trump has virtually no interest in policy making. This is remarkable. He seems not to like, let alone relish, all the detailed work that has to go into creating public policy. His attitude is that if it covers more than a page or so he just blocks it out. This abstinence on the part of the White House deprives the Republicans of a crucial weapon in their crusade. It puts the entire burden for policy making on Congress where the fault lines within the Republican caucus are constantly exposed. It is shocking to note how little of substance has occurred so far: Trump has plastered the walls with executive orders, but has yet to introduce legislation of substance. It’s as if he totally disdains governing and that winning election was all that mattered. In this context we will soon all be used to dismissing his every utterance, since we know it will never be backed up with action.
2. The hodgepodge nature of the Republican health care plan reflects their deep, and probably unbridgeable, divisions. They seem never to have discussed making health care policy at all. The plan released yesterday is easily seen through as a political fudge rather than as an act of policy making. It tries to offer each faction within the Republican party something to get behind, and in so doing offers everyone nothing. In particular, the plan appears to have no strategic goal. Is it supposed to offer maximum coverage? Does it offer less coverage but more choice? Is it an attempt to rein in cost? Or is it the basis for the exit of government from health care altogether? It matches none of these, and some of its features appear to doom it to failure within a few years. Do the Republicans really want to be associated with a health care crisis of their own doing?
3. Already opposition outside Congress is fully mobilized: various professional organizations and associations have come out against the plan, key retiree groups are adamantly opposed, and many Republican governors in states that expanded Medicaid coverage under Obamacare are especially upset. This combination of opposition will almost certainly prevent the legislation from passing in its current form, and probably prevent a compromise from emerging because many of those interests are irreconcilable.
4. The Republican leadership is, nonetheless forging ahead into the valley of death. Why? Because after seven years of whipping up their base of voters with scare stories and promises of repeal they have no choice but to plunge forward. I imagine they had hoped that failure to repeal Obamacare could be pinned on the Democrats in Congress and so be used in the next round of elections, but that now appears a non-existent option. Failure will be due entirely to the divisions in their own ranks. Perhaps they want this: if the plan goes down in flames they can blame their own extremists and, possibly, defang their right wingers for future policy making. I wish them luck in that endeavor.

At the very least the next few weeks will be interesting as the entire Republican establishment squirms in full view. The White House has already thrown its weight behind the plan — the White House has not produced its own plan — even though it fails to meet Trump’s publicly stated goals. Currently there are three alternatives on offer each from a different Republican faction. The politics look intractable. The games are now beginning as the leadership looks for a plan that can garner sufficient votes to pass. Right now that appears impossible. But who knows?

Meanwhile public approval of Obamacare is rising. The likelihood is that we will end up with a revamped or modified version of Obamacare because that has always been the best solution: fix the old law rather than tossing it out and introducing a new law that will, no doubt, need fixing. In which case all the huffing and puffing since Obamacare’s introduction would have been for naught.

Winston Churchill once said that we can rely on the Americans to do the right thing only after they have tried all the wrong things. So it appears with health care. We will end up with single payer eventually. But only after decades of pointless partisan bickering, and only after the self-evident failures of our current system have brought it to its knees.

America is not a good place to be poor and sick. There is no compassion or sense of community to rely on to reduce sickness in the poor. Health care is just another commodity to be bought and sold. And if you can’t afford it, well that’s just tough. This is America after all.