Back to the Future: Before America was Great (Again)

LBJ supported the Great Society programs of the 1960s and got them through Congress doing what he did best: buttonholing and strong-arming his former colleagues on the Hill. He knew this victory would come at a cost — a loss of Democratic control of Southern Congressional seats and state houses — but he probably would not have predicted the way in which the chickens have come home to roost.

In taking the latest step towards dismantling the Affordable Care Act, the Senate Republicans have reneged on promises to not build on the House bill and go their own way, and have released a draft Senate bill, concocted in secret, that hews closely to the House bill. (Why? Because this whole exercise has to run as a “budget reconciliation” drill that frees Republicans from having to worry about getting an unattainable 2/3 majority to support it. Query whether all provisions of the bill actually qualify as “budget reconciliation.”) Both are heavily laden with below-the-Beltway cynicism; for example, the sections of the bills eliminating Medicaid as we know it would not take effect until 2024, thus allowing Republicans to claim in their upcoming re-election campaigns that they voted to eliminate Federal handouts to the undeserving poor while at the same time not actually disadvantaging some of their constituents, and giving a future Congress the opportunity to reverse at least some of the damage before new rules take effect.

(For more details on the bills, see the many stories available online, including these, and also the excellent Twitter feed of Andy Slavitt, former Acting Adminstrator of the Centers for Medicare and Medicaid Services, who was responsible for implementing the Affordable Care Act. Here’s a WaPo chart summarizing major changes the bills would make, and here are some highlights from Politico.)

The House and Senate bills are both more about tax reform and wealth redistribution — to the rich (e.g. handouts to the 1% — including the stupefyingly retroactive cut in capital gains tax for certain high-income taxpayers; how can anyone argue with a straight face that a retroactive cut will help incentivize investment?) and less about health reform, as is clear from the effects of the House bill, as scored by the CBO (the Senate bill’s effects are reportedly slightly less extreme, thus angering great friends of the American people like Rand Paul and Ted Cruz, who thus far are demanding greater ruthlessness in exchange for their support). The Affordable Care Act funds health care coverage expansions through a series of taxes. (There is no free lunch.) The bills on the table will reduce Medicaid programs and will reduce premium support for private plans, thus inflicting great harm on the public. The anti-communitarian rugged individualism of the Republican bills, promoted by Congressional leadership who are apparently more scared of the Koch Bothers’ ire and interested in holding onto their seats than they are devoted to protecting the interests of their constituents, throws all Americans under the bus — including those who this charade pretends to help. Even industrialists need a workforce that can get to work on a regular basis. Without the availability of basic healthcare coverage and healthcare services, we roll the calendar back to an earlier age, where morbidity and mortality rates were much higher: that inevitable increase in death and disease must be laid on the doorstep of Congressional Republicans. Who do they think they are serving?

We have all learned by now that statements made by 45 are not made for the truth of their content. Most are performative, dog-whistle statements intended to be heard in a certain way by certain constituencies. His campaign rhetoric on healthcare reform (repeal Obamacare, no change to coverage of pre-existing conditions, better coverage at lower cost, etc.) is no exception: it appealed to his base, but clearly was not intended to be “true” in the ordinary sense. McConnell’s statement [autoplay video; sorry] regarding the Senate bill is equally detached from reality.

The Republican glee at the prospect of dismantling Great Society programs also includes Paul Ryan’s previously expressed desire to gut Medicare once Congress is done with reducing Medicaid from an entitlement program to a block grant program with so much flexibility at the state level as to render Federal guidelines virtually meaningless. It is part and parcel of the broader goal of dismantling federal government itself, the deep state, the globalist conspiracy, and all the other bêtes noires of the addled Right.

It should not be too much to hope that Congressional Republicans will wake from their Koch-induced fever dreams before they do too much damage to the Republic and to our Great Society.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting