Wednesday, July 19, 2017

Too Bad, So Sad

Shattered dreams.

I'm so sorry, guys. I know how it feels.

I know because I've been there. I've built my life around a single goal, allowed it to influence every decision, worked so hard for it that all other priorities fell away. For me, that goal was to be ordained an elder in the United Methodist Church. It took me ten years to achieve it, then just five for it to fall away. It was my second divorce that really drove the message home: it was unhealthy for both me and everyone I loved for me to continue clinging to that goal, and so I left ministry, initially on a leave of absence, but finally, two years later, as teaching began to open up for me, for good. Giving up on that dream was as painful as either divorce, and for similar reasons: it wasn't just what I wanted; it was, to a very large degree, who I was.\

So I understand what Paul Ryan, Mitch McConnell, and Donald Trump must be feeling right now. All three of them staked their political legacies on a single goal: repeal the Affordable Care Act, and with it, the very idea that health care could be an entitlement. They had different reasons for wanting this. For Donald Trump, it was pandering to that part of his base that was the former Tea Party, a reactionary conglomeration of ill-informed grass roots Republicans who didn't understand that the Medicare they enjoyed was a far more socialist program than the market-oriented ACA, or that the expansion of Medicaid many more of them were now enjoying was also part of the ACA. For most of them, all it took to hate the ACA was to call it Obamacare. Trump really had no understanding of how the whole thing worked (some of his statements during the campaign make it an open question whether he realized Medicare and Medicaid were two different things, and he confessed once in office that he had never known health care could be so complicated), but he knew how to fire up a crowd: Build the wall! Repeal Obamacare! Lock her up! Whether he personally believed in any of those slogans was beside the point: they got him applause, so he embraced them.

Mitch McConnell's drive to repeal the ACA was entirely political in its motivation: his small, fragile majority in the Senate had been put there in large part by the same Tea Party who had narrowly handed Trump an electoral college victory. Not to deliver on that signature promise, now that the GOP had not only all of Congress but also the White House, would be to admit legislative ineptitude. McConnell was known as a master of Senate rules and backroom deals. He had to deliver on this promise, or see many of his colleagues being primaried by unelectable extremists. That would put an end to the power he enjoyed as majority leader, very likely handing the Senate back to the Democrats. 

And Paul Ryan--well, he may very well be the only member of this Republican Troika who actually believes in what he's advocating. Paul Ryan is as close to a philosophical purist on health care as can be found in Washington. As a college student, he openly dreamed about doing away with Medicaid and privatizing Medicare. Both programs offended his Ayn Rand-informed belief in radical individualism. Americans should be free to choose whether or not to pay for their own health care--and if they chose not to, and became gravely ill, to face the consequences of that choice and die. The fact that health care for the terminally ill costs more than many of them will earn in a lifetime didn't enter into this equation at all, because, by this philosophy, being poor is itself a choice.

Since the passage of the ACA in 2010, most of the heavy lifting on the issue has come from the House, which, since flipping back to Republican control in that year's election, has voted more than fifty times to repeal it. For four years, those votes were turned back by the Senate. Then it, too, fell to the GOP, and for the next two years, it took a Presidential veto to save the program. With Trump's election, Republicans finally had in their grasp something they had been advocating for since Congress had begun working on the ACA in 2009: its complete repeal and replacement.

And there was the sticking point: for eight years, Republicans had been all about first rejection, then repeal, but had never expended any effort on proposing an alternative. Besides the frequent votes on repeal, they had fought the ACA in the courts, only to have it repeatedly reaffirmed there, with only slight modifications. But never had they come up with anything approaching a feasible replacement for an approach to universal care that had actually originated in the conservative Heritage Foundation think tank.

As complicated as American health care is, there are, in fact, simple solutions to the twin problems of coverage and cost. The more palatable is called single payer, a system that consolidates all health insurance into a single government entity, which then negotiates with drug companies and health providers to arrive at affordable prices. More extreme would be to completely socialize the industry, creating a national health service in which all medical professionals are government employees. The first approach would cut into the profits enjoyed by health corporations and doctors; the second would put all of them on a modest public salary. Either option would mean phasing out the health insurance industry, a massive private bureaucracy with far more employees than could be absorbed by the federal agency that would replace it. As someone who has experienced both national health (during my two years in England) and a privatized version of single payer (as a Kaiser Permanente member), I think most Americans would adjust quickly to such a change, and learn to love both the simplicity and economy of either system. But since both, of necessity, involve handing over private industries to federal entities, neither is acceptable to Republicans.

In fact, the ACA has always been an overlay to our current, ridiculously complicated profit-oriented system, and there simply are no more conservative approaches that would cover more people at lower cost. Ryan first, and now McConnell, kept coming up against this harsh truth: they already had the most Republican approach to covering most Americans in place, and there was no way to make it more Republican without stripping millions of Americans of their health benefits. To address the wishes of their most rabid supporters, they would have to alienate many more of their constituents, who were never going to blame Democrats for what would obviously be a Republican crime against humanity.

And so it crumbled. There was no way to amend the Senate replacement that could appeal to both moderates and conservatives. Seeing he could not bring his Frankensurance to the floor, McConnell proposed a full repeal of the ACA, with a from-scratch replacement legislation to follow. That, too, bit the dust, as his own senators realized instantly that such an approach would be even less acceptable to voters--not to mention prolonging the replacement agony for years to come.

Trump is still rumbling about "allowing Obamacare to fail," which, of course, means actively sabotaging the subsidies and exchanges through which it makes insurance affordable for middle class Americans not already covered by their employers. He's also attempting to pass the buck on both the failure of the repeal initiative and whatever happens to the ACA. It won't work: as Republicans have demonstrated for the last eight years with their constant assault on Barack Obama, this President owns everything that happens during his regime, whether or not he had anything to do with it. In fact, his disengagement from the entire repeal process, along with the empty platitudes he dished out about how whatever Congress came up with would be great, may help many Republicans to join the millions of Democrats who have been holding him accountable since even before he took office.

So yes, it hurts, and it's going to go on hurting for a very long time. Ryan, McConnell, and Trump will not soon live down their utter failure to cobble together acceptable health care legislation, and its rancid flavor is likely to bleed into their other pro-business, anti-proletarian policy initiatives. Should either chamber flip in 2018 or 2020, I expect its leader to be glad to hand the gavel to his Democratic successor, then walk away, shaking his head, wondering whatever possessed him to think that being a majority leader would be a good thing. As for Trump: this train wreck is just getting started.

The good news, guys, is that finally giving up on a dream, no matter how much it possessed you, is ultimately beneficial to your overall well-being. I am much happier in my new life as a teacher and musician than I ever was as a pastor. Perhaps this experience will lead you, Mitch McConnell, to consider retirement. Just imagine how lovely it could be not to have to wrangle 52 distinctly individualistic senators into agreeing on a piece of legislation that will cause the entire nation to hate your party and drive you from power. And Paul Ryan: wouldn't you be happier purveying those Randian ideas as a professor? Those undergrads would have to listen to what you say, because it will most likely be on the final.

As for President Trump: come on, already. Give it up. The only people giving you what you want are a handful of deplorable autocrats. You were far more popular firing people on a crappy reality show. Return to "The Apprentice" in the same way Arnold went back to being the Terminator, and I'd be willing to bet you'd have even better ratings than you did pre-White House.

Or you could stubbornly hang on until Congress, which no longer has anything to lose and everything to gain by finally rejecting you, begins impeachment proceedings. Your choice.

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