I Wish I’d Said It This Well

Paul Waldman writes for The Washington Post. His new column echoes much of what I posted yesterday with the title “On the Bright Side, ACA-Wise”.

Only Mr. Waldman writes for a living and has an editor, so you might want to take a look. His piece is somewhat optimistically called “Donald T___ may have just destroyed the Republican effort to repeal Obamacare”. Please don’t tell him or his paper that most of it is available here. I’m going to have enough trouble because of this:


Quoting Mr. Waldman:

When even the most committed Republicans came around to support Donald T___ in 2016, they made a kind of bet. It wouldn’t matter much that T___ had no apparent fealty to conservative ideology or that he was a complete ignoramus about policy, because he’d be leaving all that boring stuff to them. The Republican Congress would pass its agenda, he’d sign whatever they put in front of him, and they’d all live happily ever after.

But now it’s not looking so simple. In fact, T___ just dealt a huge blow to their top priority: repealing the Affordable Care Act. Accomplishing repeal without causing the GOP a political calamity is an extremely delicate enterprise, and the last thing they want is to have him popping off at the mouth and promising things they can’t deliver. Which is what he just did:

President-elect Donald T___ said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody”….

“We’re going to have insurance for everybody,” T___ said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better”.

We should begin with the assumption that nothing T___ says can be taken at face value; the “plan” that he claims is being devised could be no more real than the secret plan to defeat the Islamic State he used to claim that he had formulated. But that’s not the point. What matters is this: Donald T___ just emphatically promised universal health coverage. That’s an absolutely gigantic promise, and it’s one that Republicans have no intention of keeping.

But now they’re stuck with it. Democrats will be saying, “President T___ promised that everyone would be covered!” every day for as long as this debate goes on. Every time a congressional Republican is interviewed on this topic, they’ll be asked, “President T___ said that everyone would be covered. Does your plan do that?”, and they’ll have to bob and weave as they try to avoid admitting the truth.

That’s because the Republican plan, in whatever final form it takes, will absolutely, positively not cover everyone. Universal coverage isn’t even one of their goals. Republicans believe it’s much more important to get government as far away from health care as possible. In place of the ACA’s expansion of Medicaid and subsidies for the purchase of insurance that have extended coverage to 20 million more people…, they’ll be offering some tax credits and health savings accounts, which would be very good for the healthy and wealthy, but not so great for other people.

They call this “universal access,” which is meant to sound like “universal coverage” but is actually nothing of the sort. The truth is that there are really only two ways you can achieve universal coverage: by having the government cover everyone in some form of single-payer, or with a set of extremely coercive mandates to carry coverage, much more coercive than the ones in the ACA. Republicans would rather pluck out their own eyes than agree to either one of those. So the trick is to make the public think they won’t take away coverage from tens of millions of people, while doing just that.

That requires some rhetorical subtlety, which is something T___ is just not capable of…. T___ says whatever comes into his head, and whatever seems like it might be popular. People hate out-of-pocket costs, so he promises low deductibles. People don’t like the idea of tens of millions losing their coverage, so he promises that everyone will be covered.

And now, congressional Republicans are going to have to answer for breaking a promise they didn’t even make. At a moment when opposition to the repeal of the ACA is gathering strength, this was the last thing they needed.

I don’t know if it will be so hard for Republicans to admit they’re not offering universal healthcare or “insurance for everybody”. Making stuff up is part of T___’s act and they can always say he “misspoke”. In addition, they’ll claim that their plan will insure almost everyone through the miracle of untrammeled competition (sure, competition between giant corporations that avoid price competition if at all possible). And T___ will keep saying he’s solved the healthcare problem even though it’s obvious he hasn’t.

But it still seems like a good thing that he keeps saying he wants what we want and what sleazeballs like Sen. Mitch McConnell and Speaker Paul Ryan don’t. In parlous times, we must thank the Lord for small favors.