In 2010, the last time we had a rousing, countrywide debate about health care, Republicans had a semi-legitimate excuse for opposing a plan that would mandate every American have access to affordable care. The implementation of any new, major government program could result in myriad unforeseen consequences, the conservative line of thought went. The website might crash, deductibles might rise; the whole thing could fail entirely. Even if the status quo was miserable and cruel — as it was with health care then — there is some small amount of merit in the conservative preference for the known over the unknown, for staying the same instead of changing.
But with the Better Care Reconciliation Act, the grim bill Republicans have drafted to replace the Affordable Care Act, the party finds itself in the opposite position. What Republicans propose in the BCRA is not a return to the pre-ACA status quo. Instead, they want to create a new, shittier version of the ACA that performs worse in every metric while slashing Medicare funding, cutting back on employer-provided plans, and hiking deductibles. If a fanatical desire to preserve the status quo was ever fundamental to the Republican platform, it clearly didn’t make it into the 21st century, where the party’s modus operandi is now change for the sake of change, consequences be damned. This incoherence might be entertaining if not for all the lives at stake, but it illustrates vividly the increasing idiocy of the conservative mind.
One can see the deterioration of the conservative thought process on full display by simply looking at the “no” votes on the bill in the Senate, where it is currently stalled for want of a 50-vote majority. Some of these "no" votes have strange justifications for their opposition to the GOP plan; Sen. Ted Cruz, for instance, wants to improve the BCRA by eliminating protections for pre-existing conditions, an amendment unpopular enough to sink the bill entirely. Wisconsin’s Ron Johnson, who also voted "no," is in a vulnerable position as a Republican in a state Trump won by only 0.8 percent. Even before Trump invited an onslaught of bad press for the GOP, Johnson only won reelection in 2016 by a 3.4 percent margin. However, none of this electoral anxiety appeared in an op-ed Johnson wrote for the New York Times last week. Johnson criticized the bill from the Cruz angle, writing that it “boosts spending on subsidies, and it leaves in place the pre-existing-condition rules that drive up the cost of insurance for everyone.” But the rules on pre-existing conditions are one of the most popular provisions of the ACA, even among Republican voters.
Republicans want to create a new, shittier version of the ACA that performs worse in every metric.
The conservative commentariat is even less coherent than our elected conservatives. Last week, David Brooks attempted to flank the BCRA from the left and right simultaneously. Brooks wrote that “measures need to be taken to assist the working class” and called the GOP health plan “cruel.” In its stead, he proposed the American Enterprise Institute’s plan to increase the Medicare age to 67 and replace insurance with individual health savings accounts. You see, the Senate bill, which would cut Medicaid and raise deductibles, is too cruel, but also not cruel enough. His solution to widespread backlash is to enact even less popular policies. Brooks is aware that Americans loathe the bill, but his understanding of public opinion ends there. Not content with one column based on this premise, the Times’ resident climate-change denier Bret Stephens repeated the pitch for health savings accounts three days later. Muddled logic and ideological confusion of this sort is to be expected from anyone who clings to the label “moderate Republican” long after the party’s last moderates were absorbed by the Democrats.
Former hedge-fund manager-turned conservative wonk Avik Roy has seen his voice amplified significantly these past few months as the health care debate has heated up. The author of How Medicaid Fails the Poor was, like Sen. Johnson, graciously given an op-ed in the New York Times, in which he stated that “if the Senate bill passes, more Americans will have health insurance five years from now than do today.” That would be nice, since a staggering 28 million are still uninsured even after the ACA. However, Roy’s assertion directly contradicts the Congressional Budget Office’s finding that the GOP plan would leave 22 million more people uninsured. Roy attributes this discrepancy to “a flaw in the CBO’s methods,” namely that they assume a repeal of the requirement to purchase insurance would result in fewer people purchasing insurance. How, exactly, this seemingly obvious assumption is catastrophically wrong is left to the imagination. Roy’s counterintuitive apologia was echoed in an interview with Vox, whose “experts” should really know better than to bring such obvious bullshit to press, but whatever. Roy is not alone in his stupidity, however. A recent op-ed in The Hill pulled this same trick, stating that the CBO report is inaccurate because it assumes that “the individual mandate is forcing swathes of the population to buy coverage that otherwise would not,” which is literally the sole purpose of the individual mandate. Let us recite some conservative mantras: Requiring something by law makes fewer people do it. The sky is green. The CBO’s math is wrong because they ignore that 2 + 2 = 5.
The conservative commentariat is even less coherent on health care than our elected conservatives.
It comes as no surprise that the ACA program least subjected to disingenuous arguments is the Medicaid expansion,which remains popular even among Republicans. Nevada Sen. Dean Heller, whose state is slowly becoming a Democratic stronghold, explicitly condemned the GOP plan for eliminating the Medicaid expansion. “You have to protect Medicaid expansion states. That’s what I want,” Heller stated during a press conference. (In response, a pro-Trump PAC ran attack ads against Heller until Mitch McConnell demanded they stop.) There are few rhetorical tricks conservatives can use to defend health care cuts for people who are disabled or in dire poverty. For young, healthy, middle-class Americans who have numerous health care options, the GOP plan will have mixed results. For people who make $10,000 a year, the projection is purely negative — they will lose coverage, few if any will be able to afford private insurance, and many will die. As a (nearly always) free, government-administered program that requires relatively little paperwork, Medicaid lacks the convoluted nature of other Obamacare provisions. The result is that 74 percent of Americans oppose cuts to Medicaid compared to 56 percent who oppose the Republican plan as a whole. Even though cuts to Medicaid are part of the Republican plan, poll respondents forget their clear opposition when confronted with the larger mess of barely-functioning programs. Medicaid is made less popular just by its association with the ACA as a whole.
If Democrats are to make gains in health policy that resist hamfisted Republican repeal efforts, the focus must be on simple, taxpayer-funded, government-administered insurance. The Republican health care strategy, brazenly sociopathic as it is, requires a confused and frustrated electorate. The labyrinthine nature of our broken health care system leaves it vulnerable to disinformation campaigns. The ACA did a lot of good, but it failed to fix this central weakness. Until the Democrats work up the courage to unanimously demand guaranteed coverage for all, we can expect the health care debate to continue plumbing the depths of inanity.