There’s broad agreement that the Republicans made a big political whoopsie when the Department of Justice argued that the entire Affordable Care Act—including protections for preexisting conditions and Medicaid expansion—should be overturned. It is also quite obvious that President Donald Trump had no idea what he was talking about when he said the Republican Party would henceforth become “the party of great health care,” just as he has little to no idea what he’s talking about on any given issue on any given day, since his brain is very much soup.
Politico reported that Republicans are “shaken” by Trump’s sudden pivot, with some “privately complaining about the president ordering them back in the Obamacare minefield.” And yet, Trump reportedly told Republicans on Tuesday that “they have to come up with ‘a plan that is far better than Obamacare’ in order to neutralize the Democratic attacks that in part cost the GOP its House majority last year.”
Just come up with a better one than Obamacare, please. On my desk by Monday.
It is very hard to say what Republicans might try to achieve this, a Better Plan Than Obamacare. There is reportedly some bipartisan support for a couple of better ideas, like ending “surprise billing,” where people who go to an in-network hospital but see an out-of-network doctor end up with massive bills. But that’s hardly a policy on the scale of Obamacare, and we don’t know who Republicans would decide needs to make up those cost differences
Some options for GOP reforms have been getting rid of protections for preexisting conditions, turning Medicaid and Affordable Care Act exchange subsidies into block grants as a way of cutting them, or getting rid of “zero premium” ACA plans entirely, so that everyone on the exchange has to pay something for their plan. (Because skin in the game, or whatever.)
Trump has no idea what he means when he says he wants a better plan than Obamacare, because what’s actually “better” for people is covering all of their needs, and more of them, without it costing them more. None of the proposals do that. The party’s fundamental approach to healthcare is terrible, and nothing they want—like Medicaid work requirements or letting insurers refuse to cover preexisting conditions—would make it “better” for people. (This is a party whose elected officials, after all, barely understand the concept of health insurance as it exists today.)
Trump is a huge dumbass who probably doesn’t realize that; he once reportedly asked why Medicare couldn’t just cover everybody, which is also my question. But the problem remains for the rest of the GOP that, with Democrats talking more and more about covering everybody and coming close to articulating an actually principled vision of healthcare as a right, the Republican response can only be, “This is too expensive” and not, “Here is our better plan to do the thing that you need.”
It all comes back to this: Republicans do not want to improve healthcare, because their goals are incompatible with any action that would actually do so.
What is the Republican Party’s goal, then? To maximize the opportunities for rich elites to extract wealth from the rest of America in whatever ways it can. Some of them kind of care about small government, a bit, but only insofar as it doesn’t contradict with that first, more important goal. In healthcare, that means they must support the continuing existence of private health insurance that makes billions of dollars by charging more in premiums than it pays out for care; they must support hospitals and doctors charging whatever they want; and they must support the pharmaceutical industry, which kills people by holding the scientific discoveries that taxes paid for hostage to the tune of thousands of dollars a month.
They have been forced to back down a little on pharma—some Republicans make the right noises about cracking down on drug prices, though their proposals are limited. Trump’s major drug price proposal would only apply to Medicare Part B—drugs that are administered at a doctor’s office—and it is strenuously opposed by some elements of the conservative Washington infrastructure, like the American Conservative Union, which takes money from pharma.
But broadly, Republicans must not only defend the status quo of predatory profit on the backs of patients, but seek to make it worse. If they were forced to articulate what they actually believe should happen in American healthcare, it would involve a lot of rapacious profiteering, unwanted and dangerous pregnancies, terrified immigrants, and dead poor people.
In order to make a “better” healthcare system, it needs more regulation, not less. It needs the government to control prices, because the market clearly won’t. It needs protections for patients. It needs to be universal. In other words, it needs to be antithetical to everything the Republican Party stands for. And it could not be more important for Democrats to continue to hammer this home, every day, at every opportunity, until everyone who might have ever considered voting for them and everyone who needs a reason to turn out in 2020 understands what the alternative is.