There have been many bad laws in US history. Some bills were poorly conceived; some were cruel and unjust; some were sold on false pretenses. Some were all of the above.
Yet has there ever been anything like “Trumpcare,” the health legislation Republicans rammed through the US House of Representatives last week? It is a miserably designed law, full of unintended consequences. It is a moral disaster, snatching healthcare from tens of millions mainly to give the very wealthy a near-trillion-US-dollar tax cut.
What really stands out, however, is the Orwell-level dishonesty of the whole effort. As far as I can tell, every word Republicans, from US President Donald Trump on down, have said about their bill — about why they want to replace former US president Barack Obama’s Affordable Care Act, or “Obamacare,” about what their replacement would do and about how it would work — is a lie, including “a,” “and” and “the.”
And what does it say about the state of US politics that a majority of the representatives of one of our major political parties has gone along with this nightmarish process?
Before taking back the White House, Republicans attacked “Obamacare” for many things. For one thing, they claimed that it was rushed through without proper debate.
They also claimed that Americans were getting a raw deal. Deductibles were too high, they claimed; so were premiums. They promised to bring these costs down, to provide, as Trump insisted he would, coverage that was “much less expensive and much better.”
Meanwhile, they promised to keep the things people liked about “Obamacare” — whether or not voters knew they were getting those good things because of “Obamacare.”
Nobody would be thrown off Medicaid; nobody would be denied affordable coverage because of pre-existing conditions.
Then came the reality of Republican legislation. “Obamacare” was debated and analyzed for many months; “Trumpcare” was thrown together so fast it is hard to believe any significant number of those voting for it even had time to read it. And it was, of course, pushed through the House without giving the US Congressional Budget Office a chance to estimate its costs, its effects on coverage, or anything else.
Even without a proper analysis, however, it is clear that “Trumpcare” breaks every promise Republicans ever made about health. Deductibles will rise, not fall, as insurers are set free to offer lower-quality coverage. Premiums may fall for a handful of young, healthy, affluent people, but will rise and in many cases soar for those who are older (because age spreads will rise), sicker (because protection against discrimination based on medical history will be taken away) and poorer (because subsidies will go down).
Many people with pre-existing conditions will find insurance either completely unavailable or totally out of their financial reach. In addition, the government-funded Medicaid social healthcare program will be cut back, with the damage worsening over time.
The really important thing, however, is not just to realize that Republicans are breaking their promises, but to realize that they are doing so with intent. This is not one of those cases where people try to do what they said they would, but fall short in the execution.
This is an act of deliberate betrayal: Everything about “Trumpcare” is specifically designed to do exactly the opposite of what Trump, Speaker of the US House of Representatives Paul Ryan and other Republicans said it would.
Which raises two questions: Why are they doing this, and why do they think they can get away with it?
Part of the answer to the first question is, presumably, simple greed. Tens of millions would lose access to health coverage, but — according to independent estimates of an earlier version of “Trumpcare” — people with incomes over US$1 million would save an average of more than US$50,000 a year.
There is a powerful faction within the Republican Party for which cutting taxes on the rich is more or less the only thing that matters. And on a more subjective note, do you not get the impression that Trump gets some positive pleasure out of taking people who make the mistake of trusting him for a ride?
As for why they think they can get away with it — well, is recent history not on their side? The general shape of what the Republicans would do to healthcare, for the white working class in particular, has long been obvious, yet many people who were sure to lose, “bigly,” voted Trump anyway.
Why should Republicans not believe they can convince those same voters that the terrible things that will happen if “Trumpcare” becomes law are somehow liberals’ fault?
And for that matter, how confident are you that mainstream media will resist the temptation of both-sides-ism, the urge to produce “balanced” reporting that blurs the awful reality of what “Trumpcare” will do if enacted?
In any case, let us be clear: What just happened on healthcare should be treated as just another case of cynical political deal making. This was a “Freedom is Slavery, Ignorance is Strength” moment, and it may be the shape of things to come.
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