On Friday, Republicans in the House of Representatives passed the American Health Care Act (AHCA) by a narrow margin, bringing a weeks-long process, filled with false starts, exaggerated reports of death, and ideological incoherence, to a close. If made into law, the bill would repeal most of Obamacare, and replace it with a hodge-podge of Republican ideas that were grafted together quickly, and apparently without any long-term thought about its effects.
I’m not going to spend many words discussing the details of the bill. I’ve summarized the bill, in part or in whole, here, here, here, and here. If you prefer an outside source, you can read Sarah Kliff’s excellent and sobering explainer on the bill here or Vann Newkirk’s analysis here. Also, I will avoid talking about the AHCA as if it is going to become law. The Senate has already decided to do their own version, and we’re going to have to wait to see what that looks like. Rather, I want to talk about what the bill says about our country, about the Republican party, and about the right, in general.
The United States has some of the best healthcare in the world, but among developed nations, we have one of the poorest healthcare systems in the world. Medical care is too expensive for many to afford, and so private companies offer insurance to help with costs, but insurance policies are too expensive for many to afford, and so many just go without. Before Obamacare, nearly 49 million Americans lacked health insurance. As of 2015, Obamacare had reduced that number to around 30 million. That’s nearly 10% of the population who aren’t covered. Some are uncovered because they choose to be, and many more are uncovered because they cannot afford it. Partly because of this, the U.S. has some of the poorest health outcomes of any country in the developed world. We rank 43rd in life expectancy and 44th in infant mortality, two of the most basic measures of population health.
These are problems we know how to fix. Nations all over the world, with big, complex economies, have fixed them in a variety of ways. In simplest terms, the solution is to have the government guarantee either health insurance to everyone, or to guarantee medical care to everyone. These solutions comes with significant trade-offs, and there is no ideal system, but there are systems all across the world that do things significantly better than we do, at a lower cost, and with better results.
But the Republican party, and the American right in general, have pretended for a long time that these problems are not solvable, or occasionally, that they’re not real problems (typical examples can be found here, here, and in much of Philip Klein’s writing). They hold that the shortcomings of our system can be better addressed through the free-market. Honest proponents of right-wing healthcare ideas do not pretend that the free-market will bring about universal coverage, or near-universal coverage. They concede that people will still sometimes be faced with costs they can’t afford, that they will have to make difficult, heartbreaking choices, and that some people will just have to pay more for their healthcare. They acknowledge these things, but conclude that the trade-offs are worth it.
The Republican party, in trying to repeal Obamacare, could have chosen to make this argument. They didn’t though; they chose instead to obscure what they were doing. They said the bill would protect people with pre-existing conditions from paying more, when it does not. They said the bill would not cause people to lose health insurance, when all independent analyses say that it will. They said nobody on Medicaid would lose coverage, even as they are slashing the program by 800 billion dollars. Over and over again, they promised people would be better off, that people would not suffer financially, that premiums would go down, and everyone would love it. All of those things are false, and I suspect that informed Republicans know it. They know it and concluded they were better off lying.
By refusing to make an affirmative argument for what they were doing, they conceded implicitly that they’re position is indefensible, at least politically, if not intellectually. Most Americans believe* what most of the developed world believes, that the government should provide healthcare to everyone. Republicans don’t believe that, but they don’t have an alternative that most people would support, and so they just pretended that the goal of their bill was taking care of people.
The American right has largely failed to make any case for the kind of healthcare system they want. There are various ideas kicking around conservative institutes, but these ideas have failed to penetrate the mainstream debate over what healthcare should look like. In the meantime, the left has, for nearly a century now, argued consistently that universal healthcare, and its political representatives have argued for the same. On the other hand, Republican politicians have concealed their policy goals from the public, and have been cagey whenever pressed on what exactly their vision is. The vast majority of people could not summarize the Republican view of healthcare, because Republican politicians have hidden it from the public at every opportunity.
So, when congressional Republicans celebrated their half-victory at the White House on Friday, Donald Trump talked about a bill that lowered premiums, lowered deductibles, and made healthcare more accessible to normal people. This isn’t the bill the House just passed, nor does it describe any conceivable bill that might pass the Senate. It’s a total farce.
Someday, I believe, universal healthcare will come to the United States. It may even happen in my lifetime. At the end of that road, the right will either have contributed something to the system, or they will have been left behind, having completely lost the argument. One day – and if something like this bill becomes law, maybe soon – the fact they have been trying to sell a bag of rubbish to the American people by lying about what’s inside will be exposed.
* Link to a Pew poll from 2017 that says 60% of Americans answered “yes” to the question “Is it the responsibility of the federal government to make sure that all Americans have health care coverage?” 38% responded “no.”