Near Consensus on Health Care: More is Better

It's easy to miss the obvious.  Democrats want more and better health care access.  The standard Republican message agrees.  Almost everyone agrees that health care access is a right.

The hardest thing to notice is the thing that is so obvious that it goes without saying. Goldfish in a bowl take water for granted.  Take a moment and notice what is not happening. The Obamacare/Trumpcare debate is all about who is actually being covered better but no one is saying, "Darned if we should have to pay for that teenager's asthma.  If she wheezes and dies on the playground, tough luck.  It is her problem, not my problem or the taxpayer's problem."

There is a fringe on the right, including Rand Paul, Ted Cruz, Ron Johnson, and Mike Lee who are opposed the Trumpcare proposal on principle.  Their argument goes in the same direction as the main GOP position: that Trumpcare provided great healthcare access for nearly everyone.   The main GOP position is that is is good; the resisting four senators say that is the very problem with it.

Off GOP message.

The four Senators are making a clear and principled argument.  There is only so much money.  They say we need to make choices between missile defense and healthcare for the working poor.  Missile defense may save millions of lives, including ours.  Health care for the children of people who work at Walmart will save hundreds of lives here and there,  but only hundreds, vs. millions.  We make the tough decisions.   

The underlying premise: health care is a consumer choice, not a right.  The parents of that teenager should have worked harder in school, got better jobs, ones with benefits.  Parents who make $22,000 a year aren't really that poor and they should have made choices on how to spend their money and should have had family coverage.  Therefore, the teenager's predicament is her family's choice.  It is the consequence of freedom and personal responsibility, not a government responsibility.

On GOP message.

GOP Congressman, Jason Chaffetz, briefly voiced this idea and immediately he and other GOP lawmakers backed off.  It looked cruel and unrealistic and mean,  and it was 180 degrees off message.   The Trumpcare message was that we were going to give people coverage, people who were losing coverage due to the problems with Obamacare and the exchanges. Trumpcare was more and better, not less.   The Trumpcare message minimizes the "losers" of benefits and assumes they will manage on their own.  

The main GOP message: Trumpcare means more and better.

Greg Walden, the GOP Chair of the House Energy and Commerce Committee whose committee had primary responsibility for shaping the Trumpcare bill, exemplifies the messaging.  Look at his language:  "More than eight months ago House Republicans unveiled a Better Way, which included our vision for repealing Obamacare and replacing it with a patient-centered, 21st century health care system. . . . We are protecting those patients living with pre-existing conditions.  We're not returning to the days of lifetime caps or annual limits. . . . We will keep our promise to not pull the rug out from anyone as we transition away from this failing law.  Under our plan, we're moving forward."

Notice what is not there in the establishment GOP message: Talk of thrift.  Talk of the hard realities of poor choices or bad luck.  Talk of people getting less because heath care costs money we don't have.  Talk of people lazy people sponging off the overburdened taxpayer.

It is as if, in a hard fought football game, there is no defense or pushback--except by Rand Paul and three other senators who are understood to be outside the mainstream.  And even their opposition confirms the main point.  They don't like Trumpcare for the same reason the main GOP says is good about it:  it covers too many people too well.  Trumpcare is not libertarian, tough minded, free market, personal responsibility, tough luck legislation.   Trumpcare is, they say, just a version of socialism.

Republicans have gotten soft--at least on health care.    

The Libertarian message.  

Establishment Republicans do not want to say straight out and clearly that we cannot afford to do everything, nor do they want to argue that in fact Trumpcare means less and cheaper, not more and better.   So we have a odd message dance.  Trumpcare goes a long way toward doing what Rand Paul wants--but not far enough for the four senators, so they oppose it for its generosity.   Meanwhile GOP messaging is that Trumpcare is actually really generous and covers more people better, and that is good, not bad.   

Alas, the message runs up against reality and truth of the proposal.  Trumpcare is less and worse, not more and better.

The CBO, Democrats, hospitals, and the media all say Trumpcare in fact reduce access to health care, which ,of course, it must because it in fact cuts costs and benefits dramatically.    The GOP establishment cannot admit it, the 4 holdout senators say it is true but not enough, and the Democrats say it is true but way too much and cruel because of it.

There are no full throated supporters of Trumpcare because it is built on a premise that was never, ever possible, but one Trump repeated in the campaign:  that we could have an Obamacare replacement that was simple, cheaper, universal, and better.  Trump and the GOP oversold it and now they are stuck with a political mess.