Trying – and Failing – to Pass the AHCA Was a National Embarrassment

On Friday, facing defections from both the right of the party and the center, House Republican leadership cancelled the planned vote for the American Health Care Act (AHCA). As of now, no new vote is scheduled, and both Republican leaders and the White House are signalling that they are planning to move on to other issues.

Not getting the bill to the floor of either chamber is an embarrassment for everybody involved, but looking beyond the political humiliation, there are also serious ethical questions regarding how the party and the President conducted themselves throughout the process. Failing to deliver on a stated priority is one thing, but Republicans didn’t just fail; they neglected their duty to take the issues facing the nation seriously. They did not just walk into a political minefield; they tried to rush through it, so that the public did not have time to figure out what they were doing. And the President did not just fail to cut a deal; he treated the issue as an unfortunate sideshow, barely worthy of his attention. The picture emerging as the smoke recedes is damning. Republicans had seven years to come up with a serious replacement to Obamacare. They didn’t. Republicans have had years to make a real case for their vision of health care, but they chose instead to lie endlessly to the American people. And Donald Trump, who campaigned hard on the promise of repealing Obamacare and replacing it with something “terrific” had ample time to gain an understanding of the issue. He did not, and never even tried.

Obamacare has real problems that should be addressed by Congress. Republicans correctly diagnosed some of those problems, but they did not bother to craft solutions to those problems. They didn’t because they weren’t telling the truth about what they thought Obamacare’s problems were. I’m sure many members genuinely believed that the problems with the Affordable Care Act (ACA) were high premiums, deductibles, co-pays, and not enough “access” to insurance. They may have genuinely believed that their colleagues were working on plans that helped solve those problems. But all of the Republicans who knew anything about health care knew that they were misleading people. Republican health care ideas were meant to solve the problems of taxes, entitlements, and regulation. They wanted to undo the taxes created to fund the ACA. They wanted to peal away the assistance given to poor people (in the forms of a robust Medicaid expansion and subsidies for poorer Americans to help them buy insurance). And finally, they wanted to strip away what they saw as onerous regulations placed on the insurance companies.

When you look at the most serious conservative health care proposals, you find that they do have a relatively consistent vision. They care about allowing insurance companies to operate with a lower regulatory load so that they can offer a wider array of plans. They think this will get more people to buy the insurance plans that are right for them. After that, they think, overall coverage will increase, premiums will decrease, and more people will be better off than before. Republicans could have made that case to the American people, but they didn’t. They chose instead to lie about the ACA, what it does, what its problems are, and, implicitly, how they planned to fix it.

Given the basic deception at the root of the way Republicans have talked about Obamacare, it isn’t surprising that when they had the opportunity to release their solution to the public, they tried as hard as they could to make sure as few people as possible had time to understand what was in the bill or what it would do. After accusing Democrats of jamming the ACA down America’s throat, they super-charged the process. They went from having no bill at all, to having a bill, and trying to vote on that bill in about three weeks’ time. They rushed it through committees without allowing it to be amended. Senate Majority leader Mitch McConnell promised that if the bill made it through the House, it would go straight to the Senate floor without alteration. They made changes to the bill the night before it was supposed to be voted on without bothering to wait for outside analysis of what those changes would do. The whole thing was designed to get the bill through Congress before members had time to hear from their constituents, and before most people had time to learn what was in the bill. Republican leadership knew they had been lying and were worried about what would happen if too many people found out they were lying.

All of that, of course, could have been helped along by a President willing and able to go out and make the case for the conservative vision of health care reform. This was where Trump was supposed to come in. Trump is rumored to be a master salesman and master negotiator. He would sell the bill to the American people and apply the right pressure to the right members to get the votes needed to pass the thing.

But Trump was completely and happily ignorant about the issue. It isn’t as if he hasn’t had the time or the incentive to learn. He went through more than a dozen televised debates in which he knew he would be asked questions about health care. He has given dozens of speeches in which he has had to talk about health care. And in the past month, he has sat through scores of meetings during which health care was discussed, often, one presumes, with some detail. Did Trump the master salesman ever indicate that he was taking his task seriously? Did he ever give anyone reason to believe he was working to understand the nature of the dissenters’ concerns? Did he go out and make a strong case for the bill or the vision behind it? No. He didn’t do any of those things. He didn’t try.

Now, Trump has certainly pitched the woes facing our health care system as major problems. He has called Obamacare a disaster, has said it is exploding, and pledged again and again to do something about it as quickly as he could. If Trump’s prognosis were correct, that would be a serious and imminent threat to our economy, not to mention the tens of millions of people on the individual health insurance market. But Trump is not taking the problem seriously, and he never has. He just says things that sound good to him, and doesn’t worry about it if it turns out to be false. He promised to cover everybody with far better care, and then didn’t seem to break a sweat when Paul Ryan handed him a bill that did the opposite of those things. He was supposed to be “the closer,” the master-negotiator who would bring hesitant members around to his way of thinking, but he has neither done nor said anything that would lead anyone to believe that he knew anything at all about why they were hesitant. He keeps saying his preference is to let Obamacare collapse on its own, something that would drastically and negatively affect millions of people, because he seems to think that after letting the insurance market collapse, he would have the leverage to swoop in and play savior. It would be a big win, even if it meant millions of people went without even basic health insurance.

Debacles like the one we just witnessed are bound to happen when we have a President more concerned with “winning” than with achieving good policy outcomes. Trump could have behaved differently throughout this whole mess. He could have done as he said he would do, and given Congress his own “terrific” health care plan. He could have elaborated policy goals he was trying to achieve and directed his policy staff to work out a plan to get there. He could have surrounded himself with people who shared his stated policy goals. He could have consulted them and learned some of the basic structures of health policy so that he could talk about the subject effectively. Doing these things would not have guaranteed success, but it would have made it clear that he was treating the issue with the seriousness it deserved. It would have given the American people opportunity to hear what the President thinks about an important issue that affects millions. It would have placed the initiative squarely in the hands of the administration, which is more effective at making a public case for its policy priorities than Congress is. It would possibly have meant a more coherent and well-constructed plan, off of which Congress could build as they saw fit. It would have meant that when negotiating for his point of view, the President would have had the knowledge base from which he could truly consider objections and alternatives. He would have known where he had room to budge and where he had to stand firm. He would have had grounds to meet with Democrats, and could have tried in good faith to reach bi-partisan consensus.

The President is deflecting blame – onto Democrats, onto the Freedom Caucus, onto the complexities of health policy – but he acted in bad faith throughout the process. When he did outline policy goals, he did so without any sort of concrete structures under-girding those goals. He is blaming Democrats, but he signed onto a strategy meant to exclude the minority party entirely. He never met with them or listened to their concerns. When “negotiating” with the Freedom Caucus, he did so with empty threats divorced from political reality, rather than with actual policy knowledge. Even after this process, the intricacies of health care policy remain as unknown to him as they were the day he announced he was running for President. He doesn’t care to know. He isn’t taking it seriously.

This catastrophe was avoidable and could very well have ended in success, but Republican leadership behaved shamefully. In the face of a pressing national issue, they responded with a laughable piece of legislation, a poorly conceived strategy for achieving it, and an incoherent and deceptive public sales message to vouch for it. The President acted as if the whole thing were an annoying bit of housekeeping rather than a serious matter affecting tens of millions of people a significant chunk of the economy. They are moving on now with nothing to show for their efforts and no prospect of returning later with more success. If they believe, as they say, that Obamacare is a disaster from which the American people need to be saved, they didn’t act like it. They acted instead as if they were trying to get a quick political victory on something they didn’t much care about, before moving onto other, more important stuff.

 

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