Over the last seven years, the Republican Party has engaged in increasingly elaborate political suicide attempts. The party has nominated cranks and erstwhile witches and Todd Akin in winnable Senate races. It has engaged in Somme-esque trench warfare within its own congressional caucus, shut down the government without a strategy for winning anything out of it, and campaigned on a sub-Ayn Randian narrative about the heroic businessman and the mooching 47 percent. And then, after all its prior efforts at seppuku failed, the party nominated Donald Trump for the presidency.
You know how that turned out.
So it would be a foolish prognosticator indeed who assumed that Thursday’s House vote for the American Health Care Act, a misbegotten Obamacare quasi-replacement with the favorable ratings of diphtheria and the strong support of almost nobody on the right who cares about health policy, will necessarily be the undoing of the congressional GOP.
Perhaps House Republicans will be saved by masterly policymaking in the Senate (don’t laugh). Republican senators are basically promising to start from scratch with their own health care bill, which could lead to anything from the Bill Cassidy-Susan Collins proposal to allow red states to use Obamacare money for non-Obamacare experiments while blue states keep things as they are, to an AHCA rewritten to make it reasonably defensible as policy and non-suicidal in its politics.
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Such a rewriting is theoretically possible: All you need to do is spend substantially more money on insurance subsidies than the House bill does, offer substantially more money to states for high-risk pools if they want to opt out of the pre-existing condition rules, and generally make the bill look less like a self-parodic exercise in cutting Medicaid to fund tax cuts for the rich. Since liberals tend to overestimate how much people value health insurance and how much effect it has on health, a better-funded alternative to Obamacare could lead to modest coverage reductions and still be less politically disastrous than some Democrats expect.
Alternatively, maybe the Senate will simply wrangle and argue and finally do nothing, and like the Waxman-Markey cap-and-trade bill of 2009 the American Health Care Act will simply evaporate. In which case House Republicans will be able to say, hey, we tried to fix Obamacare, its ongoing problems are the Democrats’ fault, and have you checked out the unemployment rate?
So there are ways in which House Republicans might yet escape the consequences of voting for such a lousy and unpopular piece of legislation. But it would not be an escape that they deserve.
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. Nominating Trump wasn’t as suicidal as it seemed only because he had the political cunning to run against the party’s ideological enforcers, while promising working-class voters not just cultural acknowledgment but material support.
As written, the AHCA basically takes Trump’s gift to the party and hurls it off the highest possible cliff. It is not just the scale of the likely insurance losses, or how much the rich benefit from repeal relative to everybody else. It’s also the gulf between that reality and what Trump and various Republican leaders explicitly promised – insisting that their plan would deliver better coverage, lower premiums, and a lot of other things that have since taken a back seat to making room in the budget for more tax cuts.
When President Barack Obama said – lyingly – that “if you like your plan, you can keep your plan,” his party ultimately paid for it. A reasonably competent Democratic Party, with something like the AHCA to run against, should be able to make Republicans pay dearly in their turn.
Indeed, the AHCA should make the Democrats’ various internal dilemmas easier to resolve. 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.
But if the AHCA stands as the chief policy distillation of Trumpism, then 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.
This sounds like a winning argument to me. However: When a party repeatedly attempts suicide and somehow staggers bleeding into political victories instead, it is reasonable to doubt the rival party’s ability to capitalize even on the worst of blunders.
So two questions loom for the Republicans who voted for this terrible bill. Can the Senate save them from themselves? And if the Senate doesn’t – can the Democrats?