The American Health Care Act

Yesterday, the House of Representatives passed The American Health Care Act, by a margin of four votes. No Democrats voted for it, and not all Republicans, though most GOP members did. Enough, at least. Immediately after its passage, a group of Democratic Congresspeople mocked their Republican colleagues by singing “Na Na Na Na, Na Na Na Na, Hey Hey, Goodbye.” We’ll see.

The AHCA was not scored by the non-partisan CBO, a strange, well nigh unprecedented omission for a bill this consequential. The best estimates of its impact, in the exceedingly unlikely event that it becomes law, would be that up to 20 million Americans would lose their health insurance. The Affordable Care Act, (Obamacare), taxed the wealthiest Americans to pay for an expansion of Medicaid benefits; the AHCA would end those taxes. In short, this is a bill that would, in all likelihood, harm many many poor people, and enrich wealthy people. It’s a bill that will kill people.

The mocking chant from Democrats suggests one likely outcome of the debate over the AHCA and yesterday’s vote; it’s going to be a very difficult achievement to run on. The attack ads basically write themselves. Twenty Republican representatives are from districts where Donald Trump lost to Hillary Clinton. The Daily Kos announced the formation of a website where you can donate money now to whichever Democrat is the nominee in those districts. It’s already the case that many Republican congressmen have been hounded from meet-your-constituents opportunities in their districts. My own treasonous crook estimable Congressman, Jason Chaffetz (R-Utah 3rd) won’t hold town halls anymore, so vitriolic is the response to his appearances. Rachel Maddow managed to fill an entire show with interviews with people who had confronted their Congresspeople. I don’t know when I’ve seen this level of anger with elected officials. People are furious. I sure am. I could barely sleep last night from sheer outrage.

Why did they do it? Why would members of the House of Representatives (who have to face the voters every two years) pass a bill that confirms every cartoonishly evil stereotype people have about Republicans? After the vote, a large contingent gathered at the Rose Garden, to hear President Trump brag about how well he and Paul Ryan had done, and to tell some whoppers about what’s in the bill and what it’s intended to accomplish. Looks like they’re happy with it. Me, I’m trying to figure out the upside. For them. There is no upside for the American people.

I haven’t read the bill. Almost no one has; Speaker Paul Ryan kept its details pretty much secret. Seth Meyers had a lot of fun at Ryan’s expense on his show last night, showing clips from the 2009 debate over the Affordable Care Act, where Ryan condemned Democrats for doing essentially everything he just did times 1000.

So here’s what I don’t get. Why did they do it? This bill is a travesty. It’s horrific public policy. It’s never going to become law; the Senate won’t vote on it. The House bill is only the first step in a long, long process that may or may not result in a law being passed. So at least some of the righteous anger I’m feeling and my progressive friends are feeling is a trifle displaced. Still, a vote was held and votes were taken. And noted. Why did they pass this piece of garbage?

At least some of the answers are clear enough. President Trump really wanted a win. He doesn’t know anything about what it means to be President, and he doesn’t know anything about public policy. But he does know wins and losses. His Rose Garden speech described the AHCA as doing lots of wonderful things it won’t actually do, followed today by this amazing comment:

Of course the Australians have better health care than we do; everyone does. ObamaCare is dead! But our health care will soon be great!

Uh, Mr. President, you do know that the ACA was a step towards an Australian-type single-payer system? Which is what you just praised? And that the AHCA is a massive step away from it? Oh, also, that ObamaCare is not dead? That’s not what the House vote accomplished; not even close. Next step, a Senate bill, followed by a reconciliation conference, followed by two more votes? With every one of those steps fraught with difficulty?

No. He doesn’t know any of that. He doesn’t know anything. I don’t even think that his praise for the AHCA constitutes lying. It’s just another flamboyant display of incompetent ignorance.

Anyway. Trump wanted a win; now he can claim one. He got a nice party, with people saying nice things about him. Ego boost. And he’s a Republican (nominally) and President of the United States (illegitimately), so the House was motivated to give him what he wanted.

Also, I think, House members do feel some obligation to live up to their campaign promises. These guys pretty much all ran on a platform of ‘repeal and reform.’ Their constituents, their base, all hate Obamacare, largely because they’re all racists they disliked the person and policies of the President whose name was attached to it. Republican Congressman have been promising their voters for years that they would get rid of the Affordable Care Act. I suppose I’ll grant them this: they felt, as a matter of personal integrity, they had to actually do it.

To the extent, of course, that the Republican base is elderly, rural, and struggling economically, they’re exactly the people who the AHCA will hurt the most. Their opposition to Obamacare was at least somewhat irrational. They were (polling data concludes) largely ignorant of its provisions. I remember visiting an elderly woman in my ward, and how astonished, and how flummoxed, and eventually how grateful she was when Obamacare paid for the treatments that saved her daughter’s life. That’s one of the great ironies in this whole health care debate. Democrats are fighting for the ACA, which demonstrably improved the lives of Republican voters.

You’re welcome.

I’ll also grant that Obamacare was flawed legislation, that premiums and deductibles were rising, and that there was a lot of anger about those realities, which is a legitimate reason to dislike the bill. Obamacare is not failing, and its problems were fixable, but I do understand that elections have consequences, and that politicians who promise to kill a piece of legislation should probably work to accomplish that if they subsequently win.

It’s also worth pointing out that the ideological underpinnings of the AHCA are conservative, and that conservatives believe that the ACA insufficiently allowed market forces to lower costs. And the AHCA is meant to correct that. They’re wrong, of course. The ACA’s problems were caused by the invisible hand of market forces; the free market is what was driving costs up.  Still, people believe what they will believe; surely conservatism drove at least some in Congress to vote this way.

Still, there’s one very obvious reason for this vote. Republicans voted for this bill because they don’t think they will face electoral consequences for doing so. That mocking chant from the Democratic side of the aisle–“hey hey, goodbye”–must have seemed, to them, toothless. Republicans are good at winning elections. They can pass the most amazing legislation, incredibly displays of utter villainy, and pay no price for it. Their base will always turn out.

This is not because the Republican base is villainous. Republican voters are not stupid, and they’re not wicked. That’s my neighbors you’re talking about; they’re good folks. But simple policies are easier to understand and support than complicated ones. Republicans are awful at governing, because simple ideas don’t make for good legislation. But they’re good at painting their votes as beneficial, and Democratic bills as sinister. Democrats are much better at legislating, better at governing. Seems to me that people who believe in government are more likely to be good at it than people who don’t believe in it. I’m good at being Mormon; I think I’d be bad at being Presbyterian. Winning is the hard part.

Fingers crossed, but this might do it. Taking away people’s health insurance is easy to understand. And, my gosh, the anger. People really are getting woke.  If we progressives play our cards right, we might indeed be able to sing ‘hey hey, goodbye’ to the Republican House majority. But we have a ton of work to do first. Time to get on with it.

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