Democracy Dies in Darkness

Wonkblog | Perspective

The GOP cannot fix itself — let alone American health care

By Steven Pearlstein

July 20, 2017 at 7:20 AM

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The Senate GOP's effort to overhaul the health-care system collapsed this week when multiple Republican senators came out against both the revamped bill and the idea of repealing Obamacare and letting the markets "fail" before replacing it. (Jenny Starrs/The Washington Post)

The inability of a Republican Congress and a Republican president to repeal Obamacare, or even just dial it back, is yet the latest demonstration that Republicans simply aren't ready to govern.

The facile explanation for this is the unresolved division, within the party, between its radical tea party populist wing and its more moderate, business-friendly establishment wing. But the bigger issue is that the party's elected politicians are unwilling to make the trade-offs that are the essence of what governing is about.

On health care, for example, they promised to lower premiums but refused to embrace any of the three approaches that could accomplish that: increase co-payments and deductibles; squeeze the incomes of doctors, hospitals and drug companies; or finance more of the country's health care through higher taxes.

Related: [Is it inequality of income we care about — or inequality of opportunity?]

They wanted to give everyone the freedom not to buy any health insurance — but also the freedom to show up at hospital emergency rooms and demand free care, or to buy insurance the moment they got sick.

Republicans vowed to eliminate all the Obamacare taxes — but not the healthy insurance subsidies for working families that those taxes were meant to pay for.

They wanted to allow insurance companies to lower premiums for the young and healthy — while denying that the inevitable consequence would be higher premiums for the old and the sick.

They wanted to shift more of the responsibility to the states for providing health care to the poor — without shifting additional resources to go with it.

They wanted to give more power to state insurance commissioners to regulate policies — while also offering insurers the freedom to ignore state regulation by selling across state lines.

Related: [The Republicans’ Obamacare repeal is one big lie]

Republicans wanted to give every American a new tax credit to help them pay for health care or health insurance — while refusing to curtail the current subsidy, the tax exclusion for employer-provided health benefits.

They promise to solve the opioid crisis — while eliminating the requirement that insurance policies cover substance abuse treatment.

This same inability to make trade-offs has also prevented action on a host of other Republican priorities.

They want to increase investment in infrastructure — but don't want to raise taxes or user fees to pay for it.

Republicans want to cut corporate tax rates nearly in half — but can't identify even a single corporate tax loophole they would close to prevent the deficit from ballooning out of control.

They are hellbent on dramatically increasing defense spending — but won't vote to authorize current operations in Iraq and Afghanistan.

They think they can deport every undocumented immigrant — without raising labor costs for businesses and prices for consumers.

They complain about the slow pace of getting the president's appointments confirmed — but refuse to give up their three-day workweeks and four months of politicking and fundraising.

Republicans complain of a lack of bipartisan cooperation from Democrats — while insisting on drafting all important legislation at meetings and luncheons of the Republican caucus.

Since gaining control of Congress and the White House in January, Republicans have been on a frantic and futile search for the political and economic free lunch. It would be overly charitable to say that, when it comes to governance, they are rusty and out of practice. In fact, they have now exposed themselves to be rank amateurs and incompetents who don't have a clue about getting important things done.

As a group, they have demonstrated a breathtaking lack of policy knowledge and sophistication, a stubborn disregard for intellectual honesty, lousy political instincts and a broken moral compass. Their leaders have forgotten what it means to lead, if they ever knew, while their backbenchers don't have a clue of what it takes to be constructive followers. If there were a bankruptcy code for politics, it's safe to say the Republicans would be in Chapter 11.

This complete abdication of governing responsibility was confirmed Tuesday when the party's nominal leader, President Trump, announced to the country, "I think we are probably in that position where we will just let Obamacare fail. … I can tell you the Republicans are not going to own it."

Even Sen. Shelly Caputo, the reliably party-line toting Republican from West Virginia, was moved to distance herself from that cynical win-at-any-cost strategy. "I did not come to Washington to hurt people," she said.

"It's almost an embarrassment being an American citizen traveling around the world … listening to the stupid s‑‑‑ we have to deal with in this country," Jamie Dimon, the chairman of JPMorgan Chase, said in an unguarded moment last week. Dimon was quick to add, reflexively, that it wasn't a Republican or a Democratic issue, but he knows better than that. Republicans were handed a golden opportunity to govern and they have blown it. This one is on them.

Read more:

Now is the time for business leaders to dump Trump, for the good of the country

When it comes to corporate tax reform, the GOP may be on to something. Really.

The business lobby's hypocritical, one-size-fits-all answer to regulation: No

Trump is putting the wolves of Wall Street in charge of America's economy


Steven Pearlstein is a Post business and economics writer. He is also Robinson Professor of Public Affairs at George Mason University.

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