With cosmic hubris and ineptitude, the Bannon-Trump-Ryan axis failed in its attempt to repeal and replace the Affordable Care Act/Obamacare with a Republican variant, latterly known as the “American Health Care Act.”
Republicans, apparently uninterested in consensus or examining the consequences of their actions, attempted to pass their new health care law with record speed. While the law failed to pass when it failed to satisfy different political factions, it also failed because it was moved towards passage so quickly. No one, even the Congressional Budget Office, could understand all of the AHCA’s rapidly-changing variants.
When non-partisan and professional groups held that the original version AHCA was a bad law, and the final version seemed to be a special-interest free-for-all, many Americans could understandably believe our government was acting against our interests, and behind our backs.
Obamacare has been a step forward, but it is also just marginally better than what came before it. For health coverage doesn’t guarantee good coverage, or affordable coverage, or efficient administration, or good health care. That is hardly news, and many people agreed that genuine improvements in the ACA would have been welcome.
But then, like a gift from the quasi-free-market gods, came the AHCA. In its initial form, the AHCA was just Obamacare with alterations appealing to free-market and states-rights dogmatists. But opinion from health providers, insurance companies, and the Congressional Budget Office was uniform: the AHCA was worse than the ACA, saving a little, but at the cost of health insurance and possibly health care for millions.
No matter – team Trump forged ahead, boldly! But while the AHCA bill was being force-fed to Congress, three entirely predictable things happened: The nihilist Republican “Freedom Caucus” hated the bill for providing any benefits; Democrats hated the bill for being a poorly-conceived piece of junk; and Republicans representing low-to-moderate income districts worried about the AHCA’s lack of benefits. In retrospect, the AHCA was probably dead on arrival.
Less predictable was the leadership’s response to this crisis, which was to make the bill worse in two rapid-succession waves: first by nominally offering more benefits (but probably just increasing costs) to placate conventional Republicans, and then removing benefits to placate the Freedom Caucus. Naturally, no one was satisfied, and although Trump wanted to force House representatives to take a stand by voting on the AHCA, the bill was ultimately just pulled late last Friday.
All that remained was for Trump to blame the Democrats for another administration failure and for us to read all about it, complete with gloating on the political left, and diatribes on the political right.
But for now, Obamacare – the law with many more than nine lives – limps on.
Weirdly enough, Trump actually did a couple of small things correctly during this fiasco. The general thrust of the AHCA effort – of speed-forcing the passage a bad law that only a few special interests liked, and most people and nearly all professional organizations disliked – was ill-advised and ill-conceived. Pandering successively to incompatible factions of his fractured political party was likewise ill-advised.
Then, Trump finally wised up and flipped off the Freedom Caucus after they ratcheted up their demands for AHCA changes. The Caucus is a group with no meaningful policy other than to avoid all meaningful policy, and they won’t be negotiated with. Trump realized that, just too late. For a time last Friday, Trump also demanded a vote on the bill, forcing representatives to take a stand. Considering the source, that’s pretty perceptive.
For a moment, I was even a little worried – it looked as though Trump might be capable enough, and emotionally stable enough, to salvage something from the AHCA initiative. However he quickly returned to form, failing to insist on the House vote, and then blaming everyone else (but particularly Democrats!) for the latest administration failure.
Really, we should be thankful this administration cannot build a coalition or pass a law. Having rushed to failure on health care, their next “new plan” is to rush forward passage of a complex tax reform package. Like their health care proposal, the consequences of the Republicans tax-reform plan are far from clearly defined.
Some economists tell us everything will be just great with a destination-based cash flow taxation scheme, but as a doctor once told me, “no one ever died from getting a second opinion.” Tax reform isn’t necessarily a bad idea, but the current practice of sneaking laws through Congress in the legislative dead-of-night merely reduces our rapidly-declining confidence in government. And lack of confidence, especially for business laws, increases the chances of you-know-what – economic turbulence.
If Bannon-Trump-Ryan treat last week’s failure as a speed check and proceed on tax reform with deliberation and transparency, just possibly the outcome this time around will be different, or even positive.