The basics of Republican health legislation, which haven’t changed much in different iterations of Trumpcare, are easy to describe: Take health insurance away from tens of millions, make it much worse and far more expensive for millions more, and use the money thus saved to cut taxes on the wealthy.
Donald Trump may not get this – reporting by The Times and others, combined with his own tweets, suggests that he has no idea what’s in his party’s legislation. But everyone in Congress understands what it’s all about.
The puzzle – and it is a puzzle, even for those who have long since concluded that something is terribly wrong with the modern GOP – is why the party is pushing this harsh, morally indefensible agenda.
Think about it. Losing health coverage is a nightmare, especially if you’re older, have health problems and/or lack the financial resources to cope if illness strikes. And since Americans with those characteristics are precisely the people this legislation effectively targets, tens of millions would soon find themselves living this nightmare.
Meanwhile, taxes that fall mainly on a tiny, wealthy minority would be reduced or eliminated. These cuts would be big in dollar terms, but because the rich are already so rich, the savings would make very little difference to their lives.
More than 40 percent of the Senate bill’s tax cuts would go to people with annual incomes of more than $1 million – but even these lucky few would see their after-tax income rise only by a barely noticeable 2 percent.
So it’s vast suffering – including, according to the best estimates, around 200,000 preventable deaths – imposed on many of our fellow citizens in order to give a handful of wealthy people what amounts to some extra pocket change. And the public hates the idea: Polling shows overwhelming popular opposition, even though many voters don’t realize just how cruel the bill really is. For example, only a minority of voters are aware of the plan to make savage cuts to Medicaid.
In fact, my guess is that the bill has low approval even among those who would get a significant tax cut. Warren Buffett has denounced the Senate bill as the “Relief for the Rich Act,” and he’s surely not the only billionaire who feels that way.
Which brings me back to my question: Why would anyone want to do this?
I won’t pretend to have a full answer, but I think there are two big drivers – actually, two big lies – behind Republican cruelty on health care and beyond.
First, the evils of the GOP plan are the flip side of the virtues of Obamacare. Because Republicans spent almost the entire Obama administration railing against the imaginary horrors of the Affordable Care Act – death panels! – repealing Obamacare was bound to be their first priority.
Once the prospect of repeal became real, however, Republicans had to face the fact that Obamacare, far from being the failure they portrayed, has done what it was supposed to do: It used higher taxes on the rich to pay for a vast expansion of health coverage. Correspondingly, trying to reverse the ACA means taking away health care from people who desperately need it in order to cut taxes on the rich.
So one way to understand this ugly health plan is that Republicans, through their political opportunism and dishonesty, boxed themselves into a position that makes them seem cruel and immoral – because they are.
Yet that’s surely not the whole story, because Obamacare isn’t the only social insurance program that does great good yet faces incessant right-wing attack. Food stamps, unemployment insurance, disability benefits all get the same treatment. Why?
As with Obamacare, this story began with a politically convenient lie – the pretense, going all the way back to Ronald Reagan, that social safety net programs just reward lazy people who don’t want to work. And we all know which people in particular were supposed to be on the take.
Now, this was never true, and in an era of rising inequality and declining traditional industries, some of the biggest beneficiaries of these safety net programs are members of the Trump-supporting white working class. But the modern GOP basically consists of career apparatchiks who live in an intellectual bubble, and those Reagan-era stereotypes still dominate their picture of struggling Americans.
Or to put it another way, Republicans start from a sort of baseline of cruelty toward the less fortunate, of hostility toward anything that protects families against catastrophe.
In this sense there’s nothing new about their health plan. What it does – punish the poor and working class, cut taxes on the rich – is what every major GOP policy proposal does. The only difference is that this time it’s all out in the open.
So what will happen to this monstrous bill? I have no idea. Whether it passes or not, however, remember this moment. For this is what modern Republicans do; this is who they are.