There
have been many bad laws in U.S. history. Some bills were poorly
conceived; some were cruel and unjust; some were sold on false
pretenses. Some were all of the above.
But
has there ever been anything like Trumpcare, the health legislation
Republicans rammed through the House last week? It’s a miserably
designed law, full of unintended consequences. It’s a moral disaster,
snatching health care from tens of millions mainly to give the very
wealthy a near-trillion-dollar tax cut.
What
really stands out, however, is the Orwell-level dishonesty of the whole
effort. As far as I can tell, every word Republicans, from Trump on
down, have said about their bill — about why they want to replace
Obamacare, about what their replacement would do, and about how it would
work — is a lie, including “a,” “and” and “the.”
And
what does it say about the state of American politics that a majority
of the representatives of one of our major political parties have gone
along with this nightmarish process?
Continue reading the main story
Before
taking back the White House, Republicans attacked Obamacare for many
things. For one thing, they claimed that it was rushed through without
proper debate.
They
also claimed that Americans were getting a raw deal. Deductibles were
too high, they claimed; so were premiums. They promised to bring these
costs down, to provide, as Donald Trump insisted he would, coverage that
was “much less expensive and much better.”
And
meanwhile, they promised to keep the things people liked about
Obamacare (whether or not voters knew they were getting those good
things because of Obamacare). Nobody would be thrown off Medicaid;
nobody would be denied affordable coverage because of pre-existing
conditions.
Then
came the reality of Republican legislation. Obamacare was debated and
analyzed for many months; Trumpcare was thrown together so fast it’s
hard to believe any significant number of those voting for it even had
time to read it. And it was, of course, pushed through the House without
giving the Congressional Budget Office a chance to estimate its costs,
its effects on coverage, or anything else.
Even without a proper analysis, however, it’s clear that Trumpcare breaks every promise Republicans ever made about health. Deductibles
will rise, not fall, as insurers are set free to offer lower-quality
coverage. Premiums may fall for a handful of young, healthy, affluent
people, but will rise and in many cases soar for those who are older
(because age spreads will rise), sicker (because protection against
discrimination based on medical history will be taken away), and poorer
(because subsidies will go down).
Many
people with pre-existing conditions will find insurance either
completely unavailable or totally out of their financial reach.
And Medicaid will be cut back, with the damage worsening over time.
The
really important thing, however, is not just to realize that
Republicans are breaking their promises, but to realize that they are
doing so with intent. This isn’t one of those cases where people try to
do what they said they would, but fall short in the execution. This is
an act of deliberate betrayal: Everything about Trumpcare is
specifically designed to do exactly the opposite of what Trump, Paul
Ryan and other Republicans said it would.
Which raises two questions: Why are they doing this, and why do they think they can get away with it?
Part
of the answer to the first question is, presumably, simple greed. Tens
of millions would lose access to health coverage, but — according to
independent estimates of an earlier version of Trumpcare — people with
incomes over $1 million would save an average of more than $50,000 a year.
And
there is a powerful faction within the G.O.P. for whom cutting taxes on
the rich is more or less the only thing that matters.
And
on a more subjective note, don’t you get the impression that Donald
Trump gets some positive pleasure out of taking people who make the
mistake of trusting him for a ride?
As
for why they think they can get away with it: Well, isn’t recent
history on their side? The general shape of what the G.O.P. would do to
health care, for the white working class in particular, has long been
obvious, yet many people who were sure to lose, bigly, voted Trump
anyway.
Why
shouldn’t Republicans believe they can convince those same voters that
the terrible things that will happen if Trumpcare becomes law are
somehow liberals’ fault?
And
for that matter, how confident are you that mainstream media will
resist the temptation of both-sides-ism, the urge to produce “balanced”
reporting that blurs the awful reality of what Trumpcare will do if
enacted?
In
any case, let’s be clear: What just happened on health care shouldn’t
be treated as just another case of cynical political deal making. This
was a Freedom is Slavery, Ignorance is Strength moment. And it may be
the shape of things to come.
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