March 12, 2017
Healthcare Reform—Backing Paul Ryan’s handiwork is a risky proposition for The White House and The Republicans
by John Cassidy*
Kevin McCarthy, the Republican House Majority Leader, went on Sean Hannity’s show on Thursday night and tried to talk up the awful health-care bill that his party had just rushed through two committees. His message was aimed at the ultra-conservative groups, such as the Freedom Caucus and Heritage Action for America, that have come out strongly against the proposed legislation. McCarthy didn’t try to claim that the bill would make health care more affordable or widely available. Instead, he defended its conservative bona fides, twice pointing out that it would repeal all the taxes that were introduced under the Affordable Care Act—taxes that mainly hit the one per cent.
Hannity, who is one of President Trump’s biggest boosters, didn’t hide his loyalties or his concern about the political firestorm that the bill has set off. “This has to work: there is no option here,” he said at one point. Later, he warned, “As soon as it passes, you own it.”
Message to Mr. Trump and the Republicans– It is not Obamacare, but Affordable Care Act
Intentionally or not, Hannity summed up the political dilemma facing Trump and his Administration. The White House has embraced Paul Ryan’s handiwork—the House Speaker is the bill’s top backer—and they are now trying together to persuade the full House and the Senate to vote for at least some version of it. But if the bill does pass and Trump signs it into law, what happens then? The health-care industry will be thrown into turmoil; many millions of Americans will lose their coverage; many others, including a lot of Trump voters (particularly elderly ones), will see their premiums rise sharply; and Trump will risk being just as closely associated with “Trumpcare” as Barack Obama was with Obamacare.
Two questions arise: Why did Ryan and his colleagues propose such a lemon? And why did Trump agree to throw his backing behind it?
House Speaker Paul Ryan–A Healthcare Reformer or just another Politician
The first question is easier to answer. For seven years, promising to get rid of Obamacare has been a rallying cry for Republicans on Capitol Hill—one supported by both Party leaders and activists, as well as by big donors, such as the Koch brothers. It was inevitable that, if the G.O.P. ever took power, it would move to fulfill this pledge, despite the human costs of doing so.
What wasn’t anticipated was that the Republican leadership would run into hostility from the right. But that, too, is explainable. After November’s election, Ryan and his colleagues were forced to face the reality that fully repealing the A.C.A. would require sixty votes in the Senate, which wasn’t achievable. Many of the things that ultra-conservatives see as shortcomings in the bill now being considered—such as the retention of rules dictating what sorts of policies insurers can offer—are in there to make sure that the Senate can pass the bill as part of the budget-reconciliation process, which requires just fifty-one votes. As McCarthy explained to Hannity, “The challenge is the process of how we have to do this.”
The more interesting question is why Trump would stake his credibility on such a deeply regressive, and potentially unpopular, proposal. During the campaign, he frequently promised to repeal Obamacare—but it wasn’t one of his main issues. Clamping down on immigration, embracing economic protectionism, rebuilding infrastructure, and blowing a raspberry at the Washington establishment were much more central to his platform.
Early in the campaign, in fact, Trump praised socialized medicine, and promised to provide everybody with health care. “As far as single-payer, it works in Canada. It works incredibly well in Scotland,” he said in August, 2015, during the first Republican debate. A month later, he told “60 Minutes,” “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”
Part of what is going on is that Trump needs a quick legislative success. He is keenly aware that, by this stage in his Presidency, Obama had signed a number of important bills, including a big stimulus package. Trump also badly needs to change the subject from Russia. It might sound crazy to suggest that a President would embrace a bill that could do him great harm in the long term just for a few days’ respite, but these are crazy times. If nothing else, the political furor surrounding the House G.O.P. proposal has eclipsed the headlines about Trump claiming that Obama wiretapped him. For much of this week, Trump has ducked out of sight, letting Ryan and his bill take the spotlight.
That’s not the only way the Russian story may have played into this. As the pressure grows for a proper independent probe of Trump’s ties to Moscow, he must retain the support of the G.O.P. leadership, which has the power to block such an investigation. It has long been clear that the relationship between the Republican Party and Trump is based on a quid pro quo, at least tacitly: in return for dismissing concerns about his authoritarianism, self-dealing, and Russophilia, the Party gets to enact some of the soak-the-poor policies it has long been promoting. For a time, it seemed like Trump was the senior partner in this arrangement. But now Republicans like Ryan have more leverage, and Trump has more of an incentive to go along with them.>
Still, even if he had more leeway to speak out against the House G.O.P. bill, is there any reason to think he would? The thing always to remember about Trump—and this week has merely confirmed it—is that he is a sham populist. A sham authoritarian populist, even.
Going back to late-nineteenth-century Germany, many of the most successful authoritarian populists have expanded the social safety net. Otto von Bismarck, the first Chancellor, introduced health insurance, accident insurance, and old-age pensions. “The actual complaint of the worker is the insecurity of his existence,” he said in 1884. “He is unsure if he will always have work, he is unsure if he will always be healthy, and he can predict that he will reach old age and be unable to work.”
During the twentieth century, Argentina’s Juan Perón, Malaysia’s Tunku Abdul Rahman, and Singapore’s Lee Kuan Yew were among the authoritarian leaders who followed Bismarck’s example. Today, if you look at the election platform of Marine Le Pen, the leader of the French National Front, you see something similar. Like Trump, Le Pen is a nativist, a protectionist, and an Islamophobe. But she is not proposing to dismantle any of the many social benefits that the French state provides. Rather, she says she will expand child-support payments and reduce the retirement age to sixty.
Trump, on the other hand, has little to offer ordinary Americans except protectionist rhetoric and anti-immigrant measures. Before moving to gut Obamacare, he at least could have tried to bolster his populist credentials by passing a job-creating infrastructure bill or a middle-class tax cut. Instead, he’s staked his Presidency on a proposal that would hurt many of his supporters, slash Medicaid, undermine the finances of Medicare, and benefit the donor class. That’s not populism: it’s the reverse of it. And it might be a political disaster in the making.
*John Cassidy has been a staff writer at The New Yorker since 1995. He also writes a column about politics, economics, and more for newyorker.com.