Moderate Cruelty in Health Care Reform

by Neil H. Buchanan

Although the news is once again being dominated by the latest bombshells about the Trump campaign's collusion with the Russian government during the 2016 election, the Senate is again moving toward a possible vote on their deservedly unpopular bill to repeal the Affordable Care Act (ACA).

The Republicans' ACA repeal effort quite literally means life and death for millions of Americans, and the only question is whether at least 50 out of 52 Senate Republicans will support Mitch McConnell's efforts to score a legislative victory on the backs of poor children, the elderly (most of whom have never been poor in their lives), and the working poor and near-poor people who do not receive health insurance through their jobs.

As I will describe below, defeat of the Trump-McConnell bill will understandably be called a victory for "moderation."  Nonetheless, it is important to keep in mind that even if the bill is killed by three dissenters, that will mean that 49 Republicans and Mike Pence would have been willing to vote for this exercise in cruelty.

Speaking of cruelty, a prominent conservative writer recently offered this admonition: "Conservatives generally, and especially faith-based conservatives, recoil from cruelty because rejection of cruelty is the essence of Scripture."

Sounds like a call to oppose the Trump-McConnell bill, right?  Sorry, but no.  The subject of that article was Trump's claim that MSNBC's "Morning Joe" co-host Mika Brzezinski was once "bleeding from a face-lift."  The conservative writer was simply worried that Trump's gratuitous misogyny was getting in the way of his hard-right policy agenda.

It is good that some conservatives have condemned Trump's cretinous attacks on yet another prominent woman, but if we are talking about Christian values, where does making sexist and nasty remarks line up against making innocent people sick and taking away their (already skimpy, but still essential) access to life-saving medical care?

Brzezinski handled Trump's attack with aplomb.  She should not have had to do so, but she was well situated to offer a defense, with access to a television audience and plenty of guaranteed sympathetic coverage, including immediate placement of an op-ed in The Washington Post.

But what will happen to the millions of women who will no longer be able to receive cancer screenings at Planned Parenthood clinics, or whose parents will be kicked out of nursing homes when Medicaid no longer covers them, if anything like the Republicans' bill passes?

The question, again, is whether there are three -- just three! -- Republican senators who will say no to the vast majority of their colleagues who are willing to harm tens of millions of people in order to notch a political win.

Because the hard-line conservatives who have expressed "reservations" about the bill -- Ted Cruz, Mike Lee, Rand Paul, and so on -- will almost surely not allow themselves to be seen voting against any bill to "repeal Obamacare,"  the question is whether there are three Republicans who are not so extremely conservative that they can see themselves standing on the side of sanity and decency.

Note that I am not calling Rob Portman, Susan Collins, Shelley Moore Capito, Dean Heller, or Lisa Murkowski "moderates," as so many news reporters have labeled them.  They are nothing of the kind.

All of them, after all, voted to put lifelong movement conservative Neil Gorsuch on the Supreme Court, even though it was obvious that Gorsuch would be "Trump's Life-Tenured Judicial Avatar," as Linda Greenhouse aptly put it in an analysis of the Court's recent term.  None of them, moreover, came to the defense of Merrick Garland -- a true moderate -- when Senate Republicans blocked his appointment for almost a year.

Despite the existence of these supposed moderates, the Senate confirmed Scott Pruitt to the EPA, Jefferson Sessions as Attorney General, Tom Price to HHS, and on and on.  (The conservative commentator whom I quoted above, the one who is so concerned about "cruelty," also described Price and Pruitt as "policy stars" of the Trump Administration.  Talk about the soft bigotry of low expectations!)

Collins and Murkowski did vote against Betsy DeVos's confirmation as Education Secretary, but those were what politicians call "free votes" (which do not change the outcome but allow a politician to avoid a public relations problem), and in any case, their fifty colleagues had no problem voting for her.

Back in January, I stopped arguing against the Beltway commentariat's obsession with the Cult of Moderation.  Instead, I suggested that Democrats should simply argue that they are already the party of moderation, which would have the additional advantage of being true.

Even the supposed lefties in the party, most prominently Bernie Sanders (who is not even a Democrat) and Liz Warren, are in favor of policies -- from economic policies like minimum wages and progressive taxation to social policies like reproductive rights and same-sex marriage -- that are very much mainstream views in America.

On health care, however, it is not even accurate to say that the Democrats are defending a moderate position.  They are defending a conservative position against a neanderthal position.  We must remember that Barack Obama championed a Republican health plan that had been hatched in a right-wing think tank, and Republicans have attacked him for it ever since.

Even so, it is dispiriting but not surprising that the argument now is about whether these not-real-moderates can be convinced to vote to get rid of a functional, conservative health care system (that their party refuses even to consider trying to improve) by making a few small changes to a wildly unpopular proposed law.

Here are two fraudulent moves that we are likely to see, as McConnell tries to convince his few reluctant colleagues to get on board:

(1) Separating the tax cuts from the health care cuts

Liberals and the many others who oppose the Trump-McConnell bill have rightly noted the link between the cruelty of the cuts to health care spending and the bill's cuts to taxes on wealthy people.  New York Times columnist David Leonhardt captures the rhetorical point well, saying that Republicans have "offered a plan that cuts spending on the middle class and the poor [and] funnels the money into a tax cut for the affluent."

That is both true and quite politically potent.  By leaning on that framing, however, the bill's opponents create space for Republicans to sever the bill into two parts.  Some Republicans have already floated the idea of eliminating some of the tax cuts in the bill, but it is obvious that the two parts could be sold separately to faux-moderates.

First, a health spending bill that has no tax benefits for rich people can be pitched as an attack on "entitlements" or "out-of-control spending" or "big government," or as an increase in "free choice."  (Republicans' notions of freedom of choice are the mirror image of that famous quote about the law, in its majesty,  forbidding "rich and poor alike to sleep under bridges, beg in the streets and steal loaves of bread.")

Second, after a decent interval of time passes, a straight tax cut bill could be easy to sell, especially to Republicans.  Even a bill to cut taxes imposed to finance the health care system can be branded as a way to reduce "oppressive" taxes on people who have "paid enough already."

(2) Reducing the number of people who will be harmed

Both halves of the Trump-McConnell bill are terrible policy, but it is especially the first half that we need to emphasize now.  The proposed cuts in spending on Medicaid and on the subsidies that allow near-poor people to afford private health insurance will cause more than twenty million people to lose access to health care under the Republicans' plan.
What is the moderate version of that?  Keeping things as they are would seem to be the right answer, because we should really be talking about making health care available to the remaining twenty million or so uninsured Americans.  Why is moving in the wrong direction -- by any amount -- somehow viewed as acceptably moderate?

In fact, while neither increasing nor reducing the number of uninsured people might seem to be moderate, even Trump's rhetoric embracing universal coverage has made clear that sitting still should itself be unacceptable even to conservatives.  Being satisfied with the status quo is hardly a position that someone who views herself to be in the "sensible center" would want to embrace.

But the point is that any proposal to reduce the number of people who will lose their coverage under Trump-McConnell -- from 22 million to, say, 14 million -- does not result in anything that could honestly be called a moderate bill.  It is somewhat less cruel than the current version, but the more moderate alternative remains: Vote no.

It is absolutely necessary, therefore, for opponents of the bill not to rely too heavily on the "spending cuts to finance regressive tax cuts" meme.  The spending cuts are where the cruelty lies.

Moreover, the fight over regressive tax cuts will never end as long as Republicans are in the majority.  They are already laying plans to eliminate the estate tax, the Alternative Minimum Tax, and many taxes on investments and businesses, as well as cutting tax rates for high-income people.

But the fight over health care is currently a fight about whether millions upon millions of Americans will, as a result of the Trump-McConnell bill, be removed from the ranks of people who have some access to health care.

If anything resembling this bill passes, a very conservative system will become even more so, and vulnerable people will suffer the consequences.  Any Republican who is bought off by moves that are advertised as moderating the bill will be lying to herself, to her constituents, or both.