Let me be the first to say that the question behind this post is so basic, and possibly so naive, that it’s embarrassing to write. When I hit “publish,” it will be with a certain amount of shame, because it amounts to a confession that there’s something fundamental about human nature that I don’t understand. Even though I read about, write about, and follow politics for a living, I can already tell that I am about to ask the questions a child would ask, and it’s possible you’ll conclude that I am a sheltered idiot who should know better.
Before we get to that question, though, let’s revisit the basics about the latest version of the AHCA that will likley come up for a vote in the House today:
—They tried this before, you may remember, but Paul Ryan and Donald Trump couldn’t whip the necessary number of votes, and rather than face certain defeat, they chose to squash the bill at the final moment. From start to finish, it was a Veep-esque absurdist debacle.
—The Congressional Budget Office estimated that the original bill would cost 24 million Americans their health insurance, raise premiums and deductibles for the elderly, gut Medicaid over time, and deliver enormous tax breaks for the wealthy. The updated bill has not been evaluated by the CBO, and won’t be until next week, but when you see the changes, you’ll realize that the number will be, if anything, worse.
—In order to win the support of the ultra-conservative Freedom Caucus, an amendment from Tom MacArthur (R-N.J.) in conjunction with Mark Meadows (R-N.C.) essentially allowed states to opt out of protecting those citizens with pre-existing conditions, which was a huge part of Obamacare:
[the amendment] would allow states to apply for waivers to what is known as community rating, which prevents insurers from charging higher premiums to different people within a certain territory, regardless of their health status. Without that protection, insurers could go back to charging people with pre-existing conditions exorbitantly high premiums, which could put coverage out of reach for many.
—This lost a slew of moderate Republicans, who realized it would be political suicide to support such a bill. Anyone with a lapse of coverage could be denied insurance based on pre-existing conditions, and even with the mandated “high-risk pools” for states who accepted the waiver, there would be incentive for healthy people to opt out, meaning those pools would be increasingly filled by the very sick, which would raise premiums to obscene levels. In many cases, this would bankrupt those with serious illnesses, and in others it would simply be so unaffordable as to be cost-prohibitive, and they wouldn’t buy insurance at all. Worse, those costs would soar over time as the “less sick” members of the pools opt out for lower costs, making the pools vulnerable to further hikes.
—Somehow, though, a last-minute amendment from Fred Upton (R-MI)—which added a relatively meaningless $8 billion to the $130 billion already allotted for those with pre-existing conditions over five years, which Chuck Schumer likened to “administering cough medicine to someone with stage-four cancer”—has the new plan on the verge of passing. This despite the fact that the Center for American Progress estimated that it would affect only about 76,000 people of the millions who would be left in the cold by the AHCA.
The situation is nip-and-tuck, but there’s every chance that it could pass the House today. The Times has a thorough recap of the changes the AHCA would make to the ACA, but the essential components are unchanged. Massive tax breaks for the wealthy, millions of citizens who lose insurance, surcharges and other enormous penalties for those with any lapse in coverage, a repeal of the employer mandate for large companies (you are not at all safe just because you have employer-based coverage), and the newly stripped protection for those with pre-existing conditions (which, disgustingly, can include sexual assault).
Every single change, up and down the line, will make things more risky for average, healthy Americans, and will significantly worsen the situation for the poor and the sick and the elderly. With rising costs, stricter penalties, and fewer safeguards for insurance companies, there’s only one reasonable conclusion to draw—if passed, the AHCA will result in death. And sure, we’re all going to die someday, but I’m talking about death that comes too soon, unnecessarily, for potentially millions of Americans. Even those who aren’t in danger of imminent death will see their personal finances depleted, and their quality of life gutted, which can only lead to the same place: death. There is no cogent argument against this, and nobody is even bothering to contest its core truth—many people will die under the new plan in ways that would have been prevented under the old one.
For what? For a series of tax breaks? For a symbolic “victory” against Obama? When we boil this bill down to its essence, what is actually good about it? What positives does it bring about in our country?
Which brings us back to my original question: Why are these Republicans okay with killing Americans, in the absence of any real need?
Sure, I know that greed and political cynicism run rampant and have a way of erasing empathy and civic responsibility, among both parties, and that tax cuts for the rich are the true raison d’etre for the Republican party. But like an annoying child that keeps asking the question “why?”, I want to bore down to a deeper level. Speaking from my place of total naivete, I can say that if I were a politician who supported something like this, I would wake up every morning ransacked by guilt. I would feel that my existence was a net negative for the human race, that I had needlessly contributed to the suffering of my own countrymen, and that I was a disappointment who had totally failed to live up to even the most basic and obvious values of life.
On a fundamental level, I don’t understand why they don’t also feel this way. Where is the guilt? Where is the sense that if they execute this clearly harmful policy, they are corrupted members of the species? How will they continue to wake up every morning and live a life of anything but total misery, knowing that they are merchants of death?
And if you can answer those questions, which are beyond me, here’s another: Why the fuck can’t anybody stop them?