GOP Priorities Don’t Resonate With Voters on Healthcare

The debate over the American Health Care Act (AHCA), the House Republicans’ attempt to replace Obamacare, has been revealing beyond all expectations. For many people, nothing is more important about this bill than the number of people it helps to buy health insurance. For the Republican leadership, however, it seems the most important value of the bill can be summed up in one word: money.

Time and again the leadership talks about the bill as if its most salient feature is the amount by which it can cut taxes or reduce the federal budget deficit. Exhibit A in this display was a tweet from Speaker Paul Ryan’s official account. The tweet was in response to a Congressional Budget Office score of the bill that said over 14 million people currently insured through Obamacare would lose their coverage under the AHCA. Ryan could have tried to combat this claim. He could have made the traditional conservative argument that a federal subsidy of health insurance for working and middle class Americans, the main beneficiaries of expanded Obamacare insurance subsidies, was not the proper role of the federal government. Instead, he fell back on the tired old GOP refrain: it will save us money.

His tweet made three positive claims for the AHCA: it would lower premiums by 10 percent; it would cut the federal deficit by more than $330 billion; and it would cut taxes by over $880 billion. Since offering these claims, he has backed them up with an amendment that cuts taxes even more while not increasing the amount of subsidies older Americans who get their insurance through the exchange would receive. This disconnect with the values of ordinary Americans, and especially those of the voters who elected Donald Trump president, could not have been made more glaring.

Despite its control of the Congress, the presidency, and the vast majority of statehouses, the GOP remains what it has been since the Great Depression—America’s minority party. Democrats have outnumbered Republicans in opinion polls in every year but one since 1932, and they outnumbered Republicans again even in the 2016 exit poll.

And that’s not simply a case of California and New York ganging up on “the real America.” Democrats outnumbered Republicans in Wisconsin, Michigan, and Pennsylvania—three of the states that pushed Trump into the Oval Office—according to 2016 exit polls. Trump owes his presidency, and Republicans owe their continued control of the Senate, to the votes of Democrats who were willing to give a Trump-led GOP a chance.

It’s not hard to figure out why Democrats have out-polled Republicans for that length of time. For years the polls have also shown that the GOP is viewed as the “party of the rich” and the Democrats as the party that will give the working person a hand up.

But in 2016 the roles were reversed. It was Hillary Clinton who was pilloried as the servant of the wealthy, first by Bernie Sanders and then by the GOP. It was Donald Trump who told working-class Democrats in the Midwest they deserved an active government that stopped unfair economic competition from foreigners (through immigration and through trade) and that he would not touch their hard-earned Social Security and Medicare. Trump took the traditional GOP priority of saving money off the table, and with that removed the traditional Democratic advantage with the voters most strategically placed to select a President.

The GOP’s focus on tax cuts and money threatens to turn the tables back in the Democrats’ favor. Obamacare’s Medicaid expansion was targeted like a laser on the working class voter. Midwestern Republican governors could see this: every one either expanded Medicaid (including Vice President Pence as Indiana governor) or reformed Medicaid so that the other element of Obamacare—the federal exchange—would increase insurance coverage.

But the way the AHCA saves money is by reducing the subsidies that would flow to the newly insured, either by reducing their exchange subsidies or by capping the growth of Medicaid expenditures. Democrats who crossed over, perhaps for the first time in their lives, to vote for Trump may have wanted many things, but losing their health insurance to save a few bucks surely wasn’t one of them.

And those voters won’t even be the ones who save the dough. The taxes that are being repealed disproportionately affect the already well-to-do, especially the 3.8 percent capital gains tax and the additional 0.9 percent Medicare tax on ordinary income that applies once a person earns more than $200,000.  Democrats often like to charge that Republicans cut programs that benefit the average person to finance tax cuts for the rich: the AHCA lets them do that with impunity.

Republican politicians need to understand that most non-Republicans do not value the freedom a wealthy person gains from lower taxes more than the spending that directly makes their lives more comfortable and more secure. There’s plenty of government spending that doesn’t fit into that category, and President Trump’s budget placed a lot of that on the chopping block.

But for most voters, money isn’t fungible and saving it certainly isn’t one of the Ten Commandments. A dollar spent on foreign aid programs is much less valuable to them than a dollar that helps them afford the good they most desire, a healthy life.

Donald Trump instinctively gets that. Conservatives mocked him in the primary for spending most of his life as a Democrat or an independent, but I think his core supporters found that a plus. When he says that companies shouldn’t make a buck by shipping American jobs overseas, his voters hear someone who values their lives over his friends’ money. He shouldn’t forget that this belief, the perception that he cares about people like them, was his greatest asset in his race for the presidency. The president should spend the dividends from that investment on this early test and make sure that the Obamacare replacement bill that finally passes values a person’s life more than it values a billionaire’s dollar.

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22 responses to “GOP Priorities Don’t Resonate With Voters on Healthcare”

  1. This is so true. To the extent there is any semblance of a conservative anything in the AHCA, it is because they are spinning it as a budget issue rather than a socialized medicine issue. This is ridiculous.

    Yes, our tax system is a mess. That is a problem to be fixed. However, that problem is not going to be fixed by propping up a failed socialized medical scheme. That is not fixing the tax problem. That is adding a second problem.

    The beauty of all this is at the same time they tout the supposed budgetary benefits, they tell us they can’t repeal Obamacare through reconciliation because it’s not a budget issue. What a crock.

  2. A great many of the conservatives and borderline Democrats who voted for Trump despite their misgivings, did so in order to assure good judges are nominated to the Supreme Court. Although it seems like we are on the way to success with the first one, there could be three more in the coming decade. I advocate making heath care reform the triangulation issue that allows those “Trump Democrats” to stick with the Republicans through 2018 and 2020. This would ensure those next few Supreme Court nominees to come from that fantastic list of Trump’s.

    Think about it this way, even if in the most extreme terms: Would you trade Medicare-for-all for the next four Justices?

  3. Most Americans have no idea what is in this AHCA bill. The Republican leadership has managed to confuse and obfuscate the issue to the point where the pros and cons you hear on cable news are basically banalities, devoid of content.

    What’s needed is a clear idea of what’s needed to restore freedom in medical care and at the same time assure everyone that they will be able to afford it. Even the conservative Freedom Caucus has been reduced to just arguing for repeal without any clear plan thereafter.

    So lets make the goals clear, and stick to basic principles: Repeal Obamacare, get the Federal government out of health-insurance (except for Medicare—for now). Beef up tax-free Health Savings Accounts to the point where most people can use them to pay for basic medical care out-of-pocket and for catastrophic health insurance (which used to be cheap). And figure out a way for people who are basically uninsurable because of poverty or bad health to get decent care (I have a plan that’s better than Medicaid).

    /Mr Lynn

    • I’ve been yelling this at my computer for years. We all know this is the way to go, and you’ve stated it beautifully. So why the !!@!*&# can’t the GOP just do it?

  4. What the GOP needs to realize is that healthcare should be treated as a basic human right, not something that should be politicized. If they truly wanted to listen to the will of the people, they would not be pushing this bogus plan by Ryan that just makes everything worse and puts a huge burden on those least likely to bear it effectively. The free market and the profit driven healthcare system in this country is why we are in the mess we are in now. Insurance companies are all out to steal from people and pay for as little as they can. The idea that we can somehow get better healthcare in this country by empowering these evil corporations is insane.

    • What is ‘healthcare’? It’s a euphemism, confounding medical care (a service), with medical insurance (a product, helping you to pay for medical care if necessary). Services and products are not ‘rights’. Do you have a ‘right’ to good plumbing? Or to a new house when yours gets flooded?

      You have the right to “Life, Liberty, and the pursuit of Happiness.” All other things you pay for—or others pay for you, which I guess is what you want.

      /Mr Lynn

      • “Life, Liberty, and the pursuit of Happiness” should include access to quality medical care. The only way to ensure that is to remove the profit motive of insurance companies and healthcare providers.

      • 1) Quality medical care is an example of the happiness which we have the right to pursue. It is not something to be given. More to the point, there is a fundamental distinction between positive and negative rights that is a prerequisite to understanding the Declaration of Independence. Your statement indicates that you either lack this basic requisite knowledge or that you are misrepresenting or obscuring such basic principles in the hope that your audience lacks such requisite knowledge.

        2) Removing the profit motive is the way to get less of something and not more of it. If that is not so, then let’s stop paying all the GS-14s, LGBT Studies Professors and New York Times reporters. By your logic, that should result in better bureaucracy, better education and better journalism.

    • The way you people act like socialism and the free market are just competing systems is choose from as if one was strawberry and one was vanilla is ridiculous.

      There is a thing called reality. In that reality, there is at any given moment a particular amount of supply and demand for any given good or service. This is then reflected in a price. This in turn affect the distribution, consumption and production of that good or service.

      Now the government can intervene and within reason, try to mitigate the effects of reality through dickering around at the margins. The problem is you people think you can just set prices, quotas etc. by fiat as if they never need to bear any relationship to the actual physical reality of supply and demand. That is — you are either oblivious to reality or you think that, like God, you can actually alter reality.

      Or perhaps even more ridiculously, you think all we have to do is liquidate the assets of the “rich” and the rest of us can live high off the hog. That idea is immoral and stupid. Among the 8,936 reasons this is so, #1 has to be: the math doesn’t work. You’d run the country for about 3 months to a year depending on how you define the “rich” and then we’d all be broke.

      Nor do you ever pay any considerations to the information costs, transaction costs and moral agency problems inherently associated with any official process which attempts to mitigate, ignore or alter reality. If you can think of it in a women’s studies seminar on Tuesday, it must be in the CFR by Wednesday. Anyone who questions this is “sexist.”

      Which then results in messes like Obamacare. Pablum about “basic human rights” doesn’t change any of that.

  5. If by “giving the working person a hand up” you mean indulging them in the illusion that no matter what it is the masses want–retirement pensions, food, elementary education, secondary education, college education, rent subsidies, cash (i.e., refundable tax credits), unlimited medical care–there are enough “fat cats” and “corporations” in the USA whose resources can be appropriated to pay for it all in the name of “fundamental fairness” or some such without having any adverse economy-wide effects; if by “giving the working person a hand up” you mean telling the masses that “society” “owes” them these things; if by “giving the working person a hand up” you mean selling such entitlements by saying that they are really “investments” in “human capital” that will benefit the economy (sort of like a reverse entropy); then yeah, the GOP is condemned to eternal minority status. But then what is even the purpose of having two parties? Why even have politics at all? (Oh, I know–to pass transgender bathroom laws!). You keep paying the Danegeld, you never get rid of the Dane.

  6. Why is the federal government involved in my private health care relationship with my doctors and insurers, all within my state? The GOP doesn’t bother arguing the fundamentals and spends time tinkering around the edges worried about budgeting on something the federal government has no constitutional authority to be involved with in the first place.

    • Perhaps the problem is we that keep expecting arguments based upon first principles from a party that has no principles.

  7. Stupid GOPe just can’t stop themselves. Ryan actually thinks he and his, and not Trump is the agenda-driver. Completely out of touch with voters, but completely in touch with his donors. I hope all this crap blows up …. cause Trump can clearly point to any and all of it and say… ” see, it’ s the swamp “. Win/win for the outsider/insurgent President when the DC crowd does that same crap they do every year. They can’t help themselves.

  8. Thank you, Mr. Olsen. This is another case of ‘check list’ conservatism getting in the way of the bigger political picture. If capitalism cannot figure out a way to achieve socialist ends when required, then socialism will be tried. However, the problem with assessing the AHCA is that it is only one part of a three-part approach. Still, the other parts may have a very difficult path to implementation so it’s important that Congress gets the first part right. If a large number of ordinary Americans lose their health coverage and that problem cannot be swiftly corrected in time for the next election cycle in two years, the Republicans may have a problem holding onto their majorities in Congress. Obamacare was in meltdown when DJT took office, so many people were going to encounter difficulties getting (or keeping) decent coverage anyway, but the fact that Obamacare was originally poorly designed is not going to carry as much weight as an argument come the next election cycle if something constructive has not been done about it. A conspiratorial mind might reach the conclusion that the members of Congress are entirely subject to their donor masters and really don’t care if DJT takes a hit on this, or if the Republican Party takes a hit since their donors largely bet on both horses anyway. As long as the donors win it doesn’t matter if everybody else loses.

    • Exactly … Except the next election cycle “in two years” really starts less than one year from now. The clock is ticking. Higher premiums and less coverage when everyone goes to renew their plans this November-January, will be hung around Republicans’ necks regardless of whose “fault” it is.

    • Speaking of socialism … three part plans are two points short of the classic five year approach.

  9. Polls on the Ryan Plan (if you believe poll numbers are accurate) aren’t necessarily reflective of Voters’ views. I’m sure many polled didn’t actually vote (nor will vote). But even so, the ‘againsts’ are surely divided between those who don’t want to pay for others’ health insurance and those who want free health insurance. No?

  10. Repealing Obamacare was never going to be painless just as Reagan’s initial monetary policies weren’t. At least, he had the courage to go forward anyway. There will never be a less risky time for Obamacare to be repealed completely and then replaced with something functional. Government, at all levels, purchase close to 50% of healthcare services (if not more) which severely distorts the free market which, then fuels inflation. It does this in our most crucial markets (education, housing, etc.) Until government gets out of healthcare, individuals’ collective healthcare choices (good and bad) will fail to correct the market and we will continue to see unsustainable prices. This is not rocket science but Republicans predictably fail to communicate the most basic principles of the free market and freedom, limited govt, prosperity, etc. They mouth the words but are about as inspiring as an actuarial. An estimated 45% of households don’t pay income tax. Speaking of tax cuts is not only dull but meaningless to many.

    Now is the time for leadersip to have the courage to take a chance on the long view and ralley their voters to do the same. I did not vote for Republicans to simply slow or stop fatal liberal economic policies. I voted for them to reverse them. We desperately need some heros, not 90 lb. weaklings.

  11. And it’s not even about losing their current plans. Most of those current plans are worthless because people are paying most of their care out of pocket anyhow thanks to the deductibles. What they need is the reassurance that when those plans are cancelled that they can easily find new plans that will meet their needs and cost less while doing it. Without that knowledge, they’re going to feel like they’re getting Obamacare 2.0 which is when we were told we wouldn’t lose what we had and many of us liked and we ended up doing it and then being forced to replace it with more expansive plans that actually paid for less of our care.

    Taxes are once-a-year even that some of those people don’t even have any liability to, so telling them they’ll lose less means very little in the big scheme of things.

  12. The problem we face is the huge infrastructure of hospitals, offices, doctors, nurses, administrators, regulators, software providers, utility providers which make up our health care industry. If you start cutting this the people whose jobs are lost will scream. Otherwise you are going to have to pay for with taxes, insurance or user fees under some kind of formulation.

  13. Replacing technocratic law A (Obamacare) with technocratic law B (RyanCare) perfectly illustrates everything American Greatest published during the election about Conservatism, Inc.