The GOP Healthcare Bill: What Went Wrong?

The vote on the Trump health care bill has been pulled. A feud between Trump and GOP stalwarts is likely to follow.

The bill, which was almost certain to meet failure—33 Congressional Republicans were publicly against it—was yanked from defeat by Trump. What gives? The President had vowed to fight for this legislation until the cows came home and passed out from exhaustion. How could this campaign have been so utterly defeated? Trump had made ultimatums, he had promised the sun and stars and after this, nothing. Will this be the ultimate fate of the GOP health care bill?

Apparently so. And while the defeat of the GOP Healthcare is politically interesting, it doesn’t exactly sink the moon in an ocean of surprises. Anybody who can read a poll knows that health care has been an issue of singular importance for the American people; a wide swath of the electorate favors, in consistently high numbers, a public option. In the last fifty years, other societies across the world have instituted some variety of public health care, and have apparently not collapsed financially or morally.

Well, what about Americans voting in the GOP and Trump? Doesn’t that prove the ACA was dead? No. A Quinnipiac poll showed just how few Americans wanted a repeal of Obamacare:

American voters disapprove 56 – 17 percent, with 26 percent undecided, of the Republican health care plan to replace Obamacare, the Affordable Care Act, according to a Quinnipiac University national poll released today. Support among Republicans is a lackluster 41 – 24 percent. If their U.S. Senator or member of Congress votes to replace Obamacare with the Republican health care plan, 46 percent of voters say they will be less likely to vote for that person, while 19 percent say they will be more likely and 29 percent say this vote won’t matter …

So, what gives?

We live in a duopoly. Rejection of one of the parties does not entail everything the spurned party represents. The American people may not like the party who gave the ACA, the Democrats. In a two-party system, a sizable portion of them may vote for the guy who says strange things, because the alternative was a candidate who promised business as usual.

But if Obamacare was put before a national plebiscite, it would pass. And that’s the political reality before us. The ACA is a deeply flawed instrument for saving people’s lives, and ought to be replaced with a better system, such as Medicare for All or any other public instrument. But given the choice between no ACA and ACA, the public favors the ACA. This is doubly true of Trump’s base, which tends to skew older and therefore relies on health care more than younger voters. John Harwood of CNBC writes:

Instead of broadly rewarding Trump’s backers, the House bill hands huge benefits to the tiny share of his voters earning the highest incomes. Their gains come at the expense of the much larger group of older, blue-collar whites who flocked to his “Make America Great Again” banner. … Whites aged 45 or older provided 56 percent of Trump’s votes. Older Obamacare enrollees would be hit particularly hard by the House bill because it curbs age-based insurance subsidies.

Say you’re a Trump voter. You have a Keystone Ice before you. Obama gave it to you. It’ll get you drunk, but it’s not very good. Suppose a guy from New York comes before you and says he’ll get you a beer that works for you. A better tasting, less filling brew that will do everything you want. Sure, you say. I’d love a vague, even better drink! Who wouldn’t?

But when it came time to bartend, it turned out what Trump and GOP wanted to offer was basically ice-water. Understandably, you’d be upset with the bartender. I would too. The GOP plan was the Merrick Garland of bills: a compromise that nobody seemed to want and that nobody could get excited for. And as in Garland’s case, the primary enthusiasm came from the President, and nobody else.

Add to this the problems of the Republican coalition. Start anywhere. Take the Freedom Caucus, to whom any government-supplied health care would be anathema. They didn’t want the GOP bill, because it didn’t go far enough in its repeal.

Or take the moderate GOP representatives, whose bases need some subsidized health care, and, in lieu of a workable Republican alternative, could not support a full repeal. Take the RINOs, who are likely glad to not have to repeal the ACA.

Or go outside the GOP, and take the Democrats, thirsty for battle and GOP failure. Nobody wanted this to work except the man on Pennsylvania Avenue, and he could not deliver, for many reasons.

They say success has a thousand fathers and failure none, but everybody had a hand in this one. In Bob Dylan’s ballad “Who Killed Davey Moore?” the singer inquires who slew a boxer, a man who fell down stone dead after a match. One by one, each person disavows complicity: I didn’t do it; it wasn’t me; not I. The GOP killed the bill, and nobody will put a hand up. This was a group effort.

Shortly after, Trump released a statement saying Republicans would work on tax reform now—as simple a project as anyone could wish. If this is the standard for the next four years, everyone who bought Art of the Deal should ask for a refund.