The Republicans were given a gift by Trump’s campaign, a grace they did not merit: the gift of freedom from the trap of dogma, from the pre-existing condition of zombie Reaganism, from an agenda out of touch with the concerns of their actual constituents.
.. Were Trump actually governing along the populist lines he promised, the intra-Democratic debate over
- “identity politics versus
- class politics versus
- making it all about Trump (and Russia?)”
would be fraught and complicated, the best course of action murky.
.. the central Democratic argument in 2018 and 2020 should be entirely clear: Trump is not a populist but just another pro-plutocracy Republican, and everything his party promised you on health care was a sham.
The House Health Care Disaster Is Really About Taxes
It’s unclear what health policy problem this bill would solve. Even for an opponent of Obamacare, it is difficult to understand why House Republicans chose this path to revamping the nation’s health care system.
.. It’s difficult to understand, that is, if you think they were passing a health care bill. It makes more sense when you realize that isn’t what they were doing at all. They were passing a tax cut — one intended to pave the way for more tax cuts.
The flaws of the bill, then, can be understood as a symptom of the flaws of the Republican Party, which has for decades maintained a myopic focus on tax cuts at the expense of nearly all else. Too often, it is a party of people who seem to confuse governing with cutting taxes.
.. Republicans have consistently had difficulty making the case for the bill on health policy merits. It’s not even clear that most House Republican lawmakers know what’s in the legislation.
.. The trick, then, is to make the health care bill’s tax cuts part of that baseline by passing them into law before a tax-reform package. This would provide Republicans with far more room to permanently cut taxes later in the year. In short, Republicans would be able to devise a tax bill that collects about $1 trillion less in revenue but that would still qualify as revenue-neutral under Senate procedure.
This is why Republicans put health care reform at the top of their agenda. Without the bill to reset the federal government’s baseline tax revenue, Republicans would be much more constrained when it came time to overhaul the tax code.
.. But the focus on tax cuts explains why they were so eager to move on an unpopular bill that they had not read and struggled to defend or even describe. And it explains why the bill is so poorly conceived as health policy.
.. Republican presidential contenders said they wouldn’t trade $1 in taxes for $10 in spending cuts? The principle applies in 2017: Tax cuts are the one thing every Republican agrees on.
The American Health Care Act’s Prosperity Gospel
a recent interview on the AHCA between Alabama’s Representative Mo Brooks and CNN’s Jake Tapper. “[The plan] will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool,” Brooks claimed. “That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people—who’ve done things the right way—that are seeing their costs skyrocketing.”
.. it’s exactly what Republicans aren’t supposed to say about their health-care bill. Most Republicans paint their support for the AHCA in terms of the deficiencies of Obamacare, the problems low-income people face obtaining affordable health-care, or a perceived inability of the country to pay for the broad benefits of the program.
.. Even provisions that are obviously more rooted in a moral background, like support for work requirements in Medicaid, are painted as pieces that will make the whole law better and benefit the lives of everyone involved.
.. Brooks’s explanation, and his close association of morality and health, with the idea that “good lives” produce good health, is just a recasting of the prosperity gospel.
What’s a religious philosophy mostly pioneered by wealthy televangelists and megachurches got to do with pre-existing conditions and Medicaid reform? The beliefs of some evangelicals connecting wealth to God’s favor became intertwined with faith healing, and both rose to new heights in the television era on the backs of men like Oral Roberts. .. faith healing was also undeniably a policy statement. It at least partially rejected the role of science in public health and encouraged a view that faith, virtue, and good works could be enough to secure healing.
.. Some proto-form of prosperity gospel animated the life and works of men like Andrew Carnegie, who neatly tied individualism, capitalism, and wealth accumulation together in his own Gospel of Wealth.
That book, a foundational defense of capitalism and income inequality based on the perceived intellectual differences and contributions of laborers and capital-owners, was also rooted in a certain form of muscular Christianity that placed health and wealth as the near-inevitable consequences of a life well-lived, and sickness as a curse for the damned.
.. one of the key indicators of a person’s lifetime health quality is that of their parents.
It’s Time Republicans Abandoned the AHCA
reconciliation allows the GOP to further undermine the stability of the ACA’s insurance market, but not to remedy its fundamental structural flaws.
.. Instead of straining with reconciliation to patch the fissures in the insurance market, the GOP should employ the regulatory powers of the Department of Health and Human Services to fix it. By repealing an October 2016 regulation that was used to prevent the sale of actuarially priced “short-term” insurance, Secretary Tom Price could reestablish a market in which health insurance is competitively priced in proportion to most individuals’ health-care needs. This would relieve the exchanges and their subsidies of much of the burden placed on them, repurposing them as a targeted safety net for the chronically ill.