by Bob Cesca
No matter how many meaningless superlatives Donald Trump blurts on Twitter, and no matter how many times the congressional Republicans try to pass something, Trumpcare will always amount to a de facto repeal of Obamacare and, with it, tens of millions of Americans will lose coverage.
The notion of a Republican replacement for Obamacare has always been a joke. For nearly eight years, they've been talking about a free-market solution to the lingering problem of healthcare in America, but the truth is they've never had a specific plan for an alternative to the increasingly popular Affordable Care Act. Simply put: the dog has caught up with the car, hopped into the driver seat, but has no fucking clue how to drive the car. Why? Because the dog isn't wired for it. It's not in the dog's DNA to be able to drive a car. Duh.
Likewise, it's not within the strict ideological parameters of modern conservatism to manufacture a healthcare system that's both universal and affordable for everyone. Doing so is completely incompatible with conservatism. Whether it's single-payer or something closer to Obamacare, universal coverage means subsidies for poor and middle class Americans. Universal coverage means steep regulations imposed on the insurers. Universal coverage means higher taxes. The Republicans, especially now that the party's been commandeered by Pepe-worshiping fascists and tea party stuffed-shirts, will never write a plan that features these three requirements.
Obamacare, for all its reparable flaws, does what no Republican can do in 2017. Obamacare provides affordable coverage for lower-income Americans by taxing the wealthiest Americans and heavily regulating the healthcare sector. Trumpcare, both versions so far, does exactly the opposite. It takes away coverage from regular people while providing a massive tax-break -- nearly a trillion dollars -- for the super-rich. This is the best they can do. Everything else they come up with from this point forward will simply be a variation of that.
Seriously, do we really believe the Republicans will come up with a better version of the shit-sandwich known as the Better Care Reconciliation Act (BCRA)? No way. Whatever they manage to come up with next might kick fewer people from their insurance, but it'll still be responsible for millions losing coverage. Worse, once these people lose coverage -- these victims of Republican ideology and ignorance, it'll be almost impossible for anyone with a pre-existing condition (which is most people) to reacquire coverage.
Again, we're talking about GOP legislation that's billed as a replacement for Obamacare, which connotes a lateral move -- an alternative that does the same thing but does it via conservative values like free-market deregulation and tax cuts. This is like being tasked with baking a cake, but instead of using sugar and flour, the substitute recipe calls for using gravel and human pus. So, then, how do you get one-sixth of the American economy to provide a service to people who can't afford it without telling the insurance industry what it can and can't do? You can't. Further, how do you help people to pay for insurance without providing help? You can't. Obamacare does it, sure, but the Republicans hate that.
The only way the Republicans will succeed in this endeavor is to abandon its ideological strictures and embrace progressive policy choices in this arena. There are two options as far as this goes. Amazingly, I believe both are achievable.
1) Trump's 'Nixon to China' Opportunity. The president might not want to invoke Nixon out loud, but there's a lesson in Nixon's historic outreach to China. You might recall from history classes that Nixon was perhaps one of America's top five most well-known anti-communists, ranked just behind Roy Cohn and Joseph McCarthy. Very few national leaders in the early 1970s had the anti-communist cred to be able to open up diplomatic relations with communist China without being labeled themselves a communist sympathizer. Similarly, Donald Trump enjoys mind-boggling support from conservative voters making him uniquely positioned on the Republican side to propose a single-payer system. After all, he's been promising healthcare-for-all since he began running.
"We're going to have insurance for everybody." 1/15/17
"Everybody's got to be covered... I am going to take care of everybody." 9/27/15
"We're gonna come up with a new plan that's going to be better health care for more people at a lesser cost." 1/25/17
Sure, I get it. He likely said these things out of sheer ignorance and duplicity -- having zero intention of doing any of these things. But if he substantively pursued it, it wouldn't contradict his public assurances.
Until the Trump-Russia story forces him out of office, he still has enough capital on the right to get away with it without being hectored out of the party. And if the single-payer plan is packaged correctly, perhaps with some Orwellian subterfuge, he might not lose much support on his right flank. Even if it doesn't pass, he will have been the first president to put single-payer on the table, winning some conditional support from progressive populists.
Of course, this will never, ever happen.
2) Fix Obamacare and Call it Trumpcare. The more practical solution to this conundrum is to fix what's wrong with the marketplaces, while simultaneously adding new regulations to curb premiums, and call the bill "Trumpcare." It's worth noting that a gigantic piece of the puzzle in terms of reducing premiums would be to re-introduce the public option. The competition from a low-overhead government insurance plan would compel other insurers to compete, thus bringing down premiums. Problem solved.
But none of this will happen because, naturally, Trumpcare's fatal flaw is that it has nothing to do with providing better, more affordable care. The worst kept secret in politics is that Trumpcare is all about cutting taxes for the rich, and you can't cut taxes for the rich while making coverage more affordable for the rest of us. It's impossible to see the Republicans successfully threading the needle. Anything they devise as a replacement will be dead on arrival as long as they plan to force people back into a pre-2010 system in which they either go without coverage or go broke trying to pay for it (hence jacking up healthcare costs overall).
Don't get happy -- don't get complacent. The Republicans will pass a version of Trumpcare, despite the protests and town halls, as long as they don't lose more than two Republican votes. Mitch McConnell has much to offer the moderates of his caucus and he'll do whatever he has to do in order to win. The Gorsuch confirmation was proof. And no matter what they come up with, it won't "replace" Obamacare, and it'll be devastating.