It’s hard not to laugh about the fact that President Trump thought it was going to be “so easy” to give people “great health care at a tiny fraction of the price.”
But as clueless as he was to believe that health insurance only costs $1 a month for 21-year-olds, it’s not like the rest of the Republican Party was much better. They never moved beyond merely having a plan to have a plan to replace Obamacare. They just weren’t as memorably vague about it as Trump was when he promised to come up with “something terrific.”
Now, for seven years, Republicans have attacked Obamacare with the same solemnity and frequency that they typically reserve for praising Ronald Reagan. They held symbolic votes against it. Then they held some more. They challenged it in court. Then they did it again over a typo. They shut the government down over it. And, now that he’s in office, Trump has even threatened to withhold some of the law’s subsidies in a not-so-veiled attempt to make the whole thing “implode.”
Throughout it all, though, Republicans haven’t been able to agree on what they want to do, only what they don’t. Which, of course, is anything like Obamacare’s alleged “big government takeover” of health care. The only problem with that is that Obamacare is not, in fact, a big government takeover. The opposite, actually. It’s just about the most market-friendly way to cover poor and sick people. Indeed, the conservative Heritage Foundation supported something a lot like it back in 1989. As did former Republican presidential candidate Bob Dole in 1993. And former Republican presidential candidate Mitt Romney in 2006. So by vilifying their old plan as unconstitutional socialism, Republicans haven’t left themselves a lot of leeway to come up with a new one.
Well, other than just going back to the way things were before Obamacare. That’s what most Republicans really want. They think insurance companies should be able to once again discriminate against people with preexisting conditions and sell plans that are only useful as long as you don’t need to use them. Or, as they call it, allowing state-based innovation and a free market in health care! Not to mention that they don’t think the government should be expanding Medicaid or otherwise giving people money to help buy insurance.
The only thing they would change about the pre-Obamacare status quo would be having more people in the kind of high-deductible plans that would force them to pay even more of their costs out-of-pocket, the idea being that this would turn price-insensitive patients into bargain-hunting consumers of health care — an idea, coincidentally, that researchers Zarek Brot-Goldberg, Amitabh Chandra, Benjamin Handel and Jonathan Kolstad found hasn’t held up when it’s actually been put into practice.
Republicans, in other words, have tied themselves in a Gordian knot. The only thing less popular than letting insurance companies charge sick people more is making people pay more out-of-pocket — especially when you’ve criticized Obamacare’s “soaring deductibles” and promised to lower them, like Trump has. So Republicans have defended their plan the best way they can: by trying to prevent people from finding out about it. According to Vox’s Sarah Kliff, Republicans have held a combined two hearings in the House and Senate about repealing Obamacare compared to the 44 Democrats did about Obamacare itself back in 2009. It’s no surprise that they didn’t wait to get the final budget scores for their bills, either. After all, how many times can you listen to experts tell you that your plan would lead to 22 million fewer people having health insurance?
But maybe the Republicans’ best trick was convincing themselves that their plan wasn’t really their plan. House Republicans, you see, passed a bill that Trump himself said was “mean” under the assumption that the Senate would make it better. At which point Senate Republicans tried to pass a bill they scribbled down at lunch that Sen. Lindsey O. Graham (R-S.C.) called a “fraud” and a “disaster,” under the assumption that the conference committee would make it better. Which is to say that Republicans could only talk themselves into voting for their plans as long as they could talk themselves into believing that they still had a secret one up their sleeves.
Republicans, then, haven’t been able to come up with a conservative alternative to Obamacare, because Obamacare is the conservative alternative. And they won’t be able to unless they’re willing to make the case that the government shouldn’t help the poor and sick get covered — or just lie about their plan. In the meantime, though, you can bet that they think they’re getting closer and closer.
Republican health-care policy is like tomorrow. It’s always a day away.