When I was in school, I was often the kid who was held down by a bully who hit me with my own hand while shouting, "Stop hitting yourself! Stop hitting yourself!" Recalling this particular memory now, I can't help but think of the Republican Party. I want to say, "Stop hitting yourselves, Republicans!" Except that no bully is holding the party down. These blows are entirely self-inflicted.
I am talking, of course, about Trumpcare 2.0, the new version of the American Health Care Act, which the House foolishly approved by a razor-thin 217-213 vote Thursday afternoon.
This new version of the AHCA succeeded where its predecessor failed because it does something congresspeople love to do: Kick the can. Instead of repealing increasingly popular ObamaCare regulations outright, the new bill gives the states the option to do it themselves. But this doesn't fix what is sure to make the AHCA a political dud, which is that millions of people will lose coverage. It also doesn't alter the health-care status quo enough to bring costs under control or increase quality of care.
Clearly, Republicans don't know what they want to do on health care. And they don't know what they want to do because they have contradictory instincts. But even if they could get their instincts in one place, they don't know how to translate them into policy.
Republicans are in denial about a central truth of the post-ObamaCare landscape: A health-care bill that doesn't cover everyone will be highly unpopular. If Republicans want to pass a bill that won't cost them at the ballot box, they need to reconcile themselves to the idea of universal coverage.
I unapologetically support universal coverage — and I'm a conservative! I share my fellow conservatives' concerns about the size of government, but the size of government is out of control thanks to other entitlements. In and of itself, universal coverage wouldn't be very expensive. The United States is still the most fantastically wealthy nation on Earth.
Conservatives care deeply about dignity, responsibility, and don't want government to encourage bad behavior. I wholeheartedly agree. But getting cancer or a chronic disease is not bad behavior. Conservatives don't want the government to help those who can help themselves, but we also agree — or we should agree — that people who can't help themselves should be helped. National solidarity is an important value, and this should translate into a system that protects people from the worst. I don't want the government to control or manage health care, but I do want government to protect people from the expenditures of catastrophic health problems.
But never mind the substance, what about the politics? Here, the picture is even starker. We're talking about health issues — life and death issues. This is something about which people are rightly very emotional, and understandably very risk-averse. You can't just take away people's safety net and replace it with fairy dust. The winning message isn't "ObamaCare is big government and big government is bad." The winning message is "We'll make sure everyone is covered for health-care catastrophes, and moreover, we'll make it happen in a way that uses common sense and puts you, not hospitals and insurers, in control of your health care."
This is a winning message. And in terms of policy, it can be done. By shifting power away from middlemen and towards consumers, through health savings accounts and regulatory reforms, Republicans can make American health care more streamlined, more innovative, and less expensive. But for that to happen, they need to pass a bill and make sure that bill doesn't destroy their majority. Before they can do that, they must come to grips with what is politically acceptable in today's America.
Americans want universal health care. Republicans need to accept this.