In a piece in the Washington Post today, EJ Dionne allegedly lays out the “three big lies about health care.” It nicely encapsulates many of the Democrats’ political arguments against repeal (though unlike many of his allies, Dionne was kind enough to refrain from accusing Republicans of manslaughter in this column.) One of them, however, isn’t a lie at all. The other is a debatable policy question, and the third is an absolute strawman.
“Lie One: Democrats and progressives are unwilling to work with Republicans and conservatives on this issue.” Dionne actually writes the following sentence: “In fact, Democrats, including President Barack Obama when he was in office, have said repeatedly that they would like to work with Republicans to improve the Affordable Care Act.”
Oh, is that what Obama said?
First off, let’s talk about the absurdity of this framing, which drives a lot of coverage. It is odd, to say the least, that even after years of wide-ranging historic wins—many of them driven by an explicit promise to repeal Obamacare—Republicans are still the ones asked to work with Democrats “to improve the Affordable Care Act.” That isn’t the issue. The question is: why don’t Democrats have to work with Republicans to find the best way dismantle Obamacare? This is the topic democracy has laid on the table. Because as Obama might say, “they won.” And won. And won.
Second off, the passing of Obamacare—even more than the policy consequences of the bill—not only decimated the Democratic Party but frayed our contemporary political order. The chances of any truly bipartisan major reform in the foreseeable future is nonexistent. Democrats were willing to push through major national restructuring of a massive chunk of the American economy without any buy-in from half the country. They created a new norm. So while no one is expecting liberals to help unravel Obama’s signature legislation, the idea that Republicans should be expected to save it is weak.
It is true that Obamacare would likely die without Republican help. “But those ‘circumstances,’” claims Dionne, “have been created by the GOP itself. A completely different coalition is available, but Republicans don’t want to activate it because they are hellbent on repealing Obamacare. Why?”
Democrats, who ignored the Constitution when it came to subsidy payments and ignored basic economics when it came to state exchanges, have only themselves to blame for writing a bad bill. Long before Donald Trump ever became president, insurance companies were fleeing state exchanges. Long before Donald Trump was president, premiums were increasing and choices were constricting.
Perhaps the ACA debate was a reflection of a coming national split, or perhaps it was partly the cause. Whatever the case, it is revisionism to claim that Democrats were interested in conservative ideas (and please spare me the individual mandate myth). The supposed liberal concessions were based on pretend hearings and meaningless feel-good letters. In truth, the only compromises that went on in earnest were between liberals who were worried about capturing the votes needed to pass any bill, and moderate Democrats who were worried that their careers would be destroyed. Both of these things would come to fruition.
“Lie Two: This bill is primarily about improving health care for American families. No, this effort is primarily about cutting taxes.” Now, it’s plausible that EJ Dionne can bore into the souls of everyone involved in the bill, but whatever you make of the Senate’s initial (moderate) proposal, and many conservatives hate it, it’s about a lot more than tax cuts. When Democrats lean heavily on their go-to platitude about tax cuts for the rich, it undermines the notion that they’re serious about negotiating on anything.
Moreover, there is nothing in Obamacare that “improves health care” for “American families” (it’s like reading ad copy.) ACA was mostly about expanding coverage, not improving care—though Obamacare’s expectations and purpose have been dramatically reimagined since 2010 to create imaginary success. If we evaluate ACA using the parameters Democrats themselves laid out when campaigning and passing, it has failed on everything other than the massive expansion of welfare. Even then, it offers “access” by threatening and forcing people to buy insurance. This is tantamount to celebrating an increase in military recruitment after passing a draft.
“Lie Three: The Senate bill is a ‘compromise.’” Dionne doesn’t offer a single example of any Republicans saying that their bill is compromise with Democrats, nor could I find one such example. So perhaps it exists, but certainly isn’t a predominant talking point. It is a compromise in the same way that Obamacare was: between wings of the same party. The only difference is that the 2017 GOP is bothering to pretend otherwise.
In Dionne’s defense, he does provide one big obvious fiction when admonishing moderate Republican senators not to vote for the GOP bill:
Do they really want to say someday that one of their most important votes in the Senate involved taking health care away from millions of Americans? I would like to believe they are too decent for that. I hope I’m not lying to myself.”
I think you are. Whatever you make of the Republican efforts to un-knot Obamacare’s state-driven control of healthcare insurance markets, none of their plans take health care away from a single American. What AHCA might get rid of is the individual mandate, which will end the unprecedented policy of forcing American consumer to buy things they don’t want. And they may—color me skeptical—follow through on rolling back future spending on Obamacare’s Medicaid expansion. Don’t worry, though: despite what you may hear about the end of Medicaid, it will still be, by far, one of the biggest items in the U.S. budget.