Republicans are bound and determined to injure themselves. They needed a Win, so they will probably get it.
More Obamacare.
They will be able to say they have fulfilled the promise to "repeal and replace" Obamacare. Then they will have to live with the political fallout.
Healthcare reform destroyed the Democratic majority in 1994 when Hillarycare took a crack at it. It destroyed the Democratic majority in 2010 when Obamacare passed. Now it is the Republican's turn.
No one will much like the law. It is too complicated to understand on its actual merits, so it will be understood by the talking points. Democrats will oppose it because it reverses the slow trend toward healthcare being a right of citizenship. (Emergency care is already a right.) There will be one big Democratic message: fewer people will be covered and they will be covered less generously. Most of the people hurt will barely understand whether they are hurt by the leftover effects of Obamacare or the new effects of Trumpcare but some of the working poor will get less, but some will get more, but generally Trumpcare will be experienced as Obamacare, only worse.
Hospitals will know they are being hurt. Healthcare in America is delivered in a haphazard way, most people covered, some not. The safety net is that everyone is covered in the emergency room and while a person is in crisis. The hospital will deal with your heart attack and collapse in the ER and cardiac care unit, but it won't help you manage your cancer treatment or diabetes. It provides enormously expensive critical care, then it will try to collect. If you have savings, it will take it all. If you do not, it will attempt to collect, ruin your credit, keep you poor, but eventually write off most of the cost.
The risk of this kept people in jobs they hated, if they had medical insurance they might lose if they lost that employment. Uninsured medical costs worried the prudent. For the working poor, living without insurance, it was a risk mitigated by their being judgement proof. The hospital could take it all, but there was little to take. The situation was a financial disaster for hospitals, and Obamacare helped stop their financial bleeding. More of the working poor were covered. Trumpcare will mean fewer people covered and more uncollectible debts for service. Hospitals will know they are hurt and will complain.
Who wins? Some prosperous people will notice they are getting a tax cut through elimination of some new Obama surcharges--3.8% of dividends and capital gains and 0.9% on regular income. Do not expect a groundswell of positive accolades by business and professional people earning top 1% incomes. A businessman earning $500,000 a year, with $200,000 coming from dividends and $300,000 coming from profits, would see a tax reduction of some $11,000, but the payments would be mixed into an already devilishly complicated tax return with various deductions for depreciations, itemized deductions, Alternative Minimum Taxes, etc., and the income from dividends was already subject to a lower tax rate than was regular income. Bottom line: Trumpcare will eliminate a couple of calculations in an already complicated situation. Prosperous people will not become a cheering squad for tax relief.
Who will praise the law? Trump will, at first. He will say it solves the disastrous problems of Obamacare and the new law is great. The primary talking point is that it is "better than Obamacare", and the conservative media will echo this message, but in actual operation the law is a continuation of insurance exchanges, with multiple complications. The chief talking point is that it is not Obamacare.
Republicans are trapped by the success of their previous messaging. They had said that Obamacare is terrible and that they would repeal and replace it. The one idea that might have political appeal would be a much broader, single payer system, but that is opposite the direction favored by the establishment Ryan small government GOP, though not necessarily by Trump himself. Trump wants something great, but he tied himself to Republicans and they want something less.
Trumpcare as it will probably get passed is shaped by the path Trump needed to take to become president. He needed to assure Republicans he was one of them, and it worked. Republican voters supported Trump. This precluded Trump from being a "new Republican", one who boldly created big programs made with Democratic votes. Briefly, in the summer of 2016, when Trump was criticizing trickle down economics and Paul Ryan, it seemed possible that Trump would be a Big Government Republican and would govern in opposition to the Freedom Caucus and small government libertarianism and trickle down. Trump-style populism was at a crossroads. Democrats were not broadly available to Trump but Republicans were, so long as he bashed Obama, Hillary, and Obamacare. The path to the White House required GOP solidarity. The result is a program that no one will like, but it is a Republican plan. Obamacare-lite. Obamacare-less. Obamacare-worse.
Trump is too good a salesman to persist selling a bad product. I expect Trump to walk away from Trumpcare once it is in place and blame it on the Congress. It will be their law, not his. Trump will say that what he really wanted was something much different, something really, really great. Trumpcare will be an orphan.
1 comment:
“Trumpcare Is Tricky Messaging for Democrats”
Yes indeed, Trumpcare could wreak political devastation on Trump and Republicans, especially if voters adopt the liberal media end-of-the-world version of the law— if it passes. But I don’t see that damage to Republicans happening whether it passes or not. Because the overwhelming thrust of the proposed law is paring back an out-of-control welfare program called “Medicaid”, Democrats have a tricky messaging task before us if we are to win voting majorities. If Democrats get tagged as being the defenders of a massive “welfare expansion for the poor and working-poor”, we will lose. Only if Democrats can get labeled “defenders of middle class healthcare insurance”, can we win.
The unfortunate electoral fact is that the Congressional fight is primarily over Medicaid. Democrats are highlighting horrors such as 49% of all American mothers will be hurt, because Medicaid pays for the maternal delivery costs of almost 5,000 of the 10,000 births in the USA each month. This argument hurts us, because it emphasizes that Medicaid is not “insurance” at all, it is welfare. The dog whistle is: Democrats cheer on poor women (minorities and legal green card immigrants) with high birth rates who can’t afford their children, so the middle class is morally obligated to pay. Worse for Democrats are opinion pieces like “Senate Republicans Ready Themselves for a Massive Theft from the Poor” (Washington Post, https://goo.gl/A6t2uU, June 22, 2017). The accusation that voters trying to control Medicaid costs are guilty of “theft” from welfare recipients is offensive, and it's another "deplorables" self-inflicted wound. Again, the dog whistle: “The poor are legally entitled to your money”. Bill Clinton once taught Democrats the winning rhetoric is “welfare” to “workfare”. He slashed billions in public assistance, and gave the states more budgetary discretion, exactly what Trumpcare proposes. Apparently Clinton's winning teachings have faded.
The Congressional Budget Office assessment of the House Bill highlighted that most of the millions who will be hurt are Medicaid recipients, not the middle class. In our liberal media bubble, we’re mostly hearing the Medicaid horror stories. In conservative media, it’s the dog whistles. But in the centrist media, there’s a more cool-headed debate over (1) the threat that uncontrolled Medicaid costs will bring down the whole private healthcare system; (2) we must have the working poor paying (with subsidies) into the private insurance markets rather than becoming “the new Medicaid class”; and (3) affordable lesser coverage is better than coverage you can’t afford to buy at all. This podcast from Wall Street Journal argues that without the essential fixes Trumpcare proposes, affordable middle class private health insurance will increasingly disappear. Listen “Senate Health Bill Sets Up Showdown Among Republicans”, (June 23, 2017 https://goo.gl/1caLzy). Listen also to “The Democrats' Post-Georgia Civil War”, Wall Street Journal, June 23, 2017, https://goo.gl/Ut8dif), reminding us that Trumpcare vs. Obamacare was very vigorously debated in the Georgia special election, and Republicans won by 4+ points.
I’m not seeing evidence that the current hyperbolic Democratic trashing of Trumpcare as a Medicaid killer is a winning argument for us. We can’t win if our message is heard as “we demand a trillion dollars in Medicaid for the poor and working poor”. It has to be “yes, Obamacare is broken, so let Democrats who have a heart reform middle class healthcare insurance markets”. We’re not going to win elections if our candidates just mimic the media focus on Medicaid. Our focus must be affordable private insurance for the middle class.
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