Over the past few days, I've published a couple of posts wherein I've tried to noodle over how we got to this moment in health care reform.
Here, I'd like to add a few observations from that and other debates and ask whether there's something important and potentially positive going on in the current political moment. One wants to be careful not to over-interpret, to lean against confirmation bias, and to recognize how quickly the political winds can shift. But let my throw a few noodles on the wall and see if they stick.
Here are some facts:
–The Senate health care bill is almost certainly dead. The House bill is highly unlikely to go anywhere, either. As I discuss in the links above, it died because of the inability of Republicans to craft and pass a plan would accomplish the following: meet Trump's promise to provide more comprehensive, yet cheaper care; provide large tax cuts for wealthy households; repeal Obamacare but not unwind its coverage gains; cover pre-existing conditions and do so while keeping private insurers on board by avoiding bifurcated risk pools. (To be clear, none of this means Obamacare is out of the woods. Trump is already talking about further ACA sabotage.)
–In trying to deal with some of these contradictions, the last version of the Senate plan retained two high-end taxes that the House and the earlier Senate plan had initially cut. Some Republicans–that's "Republicans," with an R–argued that it didn't make sense to cut taxes for rich people while cutting health coverage for poor people.
–As OTE'ers know, Republicans in the Kansas legislature recently overrode their governor's veto and ended the trickle-down tax cut "experiment" that was undermining their ability to maintain public services, including education.
–In that same spirit, some Republican governors, motivated by their perceived need to protect the ACA Medicaid expansion in their states, played key roles in defeating the Senate health bill.
–As they craft their tax cut plan, some R's are making noises about learning some lessons from the unfairness problems with their health care approach: "Benefits like the mortgage interest deduction should be more targeted to help lower and middle income people as opposed to wealthier Americans," said Rep. Carlos Curbelo (R., Fla.). "I think you're going to see a balance in our tax reform package."
All of this led my pal Jimmy P to claim, in the WSJ, that we're seeing "the waning power of the supply side, pro-growth antitax wing of the Republican Party…a moving away from the more extreme tax-cut positions."
Is it possible that enough conservatives to make a difference could be at the front edge of recognizing that dysfunction, fact-denial, claims that you're helping people when you're really hurting them, cutting programs which people depend on to give tax cuts to the wealthy–that all of that is both bad policy and bad politics?
Certainly, the House budget 2018 resolution out today suggests the answer to that question is decidedly "NO!" From CBPP's Bob Greenstein:
House Budget Committee Chair Diane Black's new proposed House budget resolution, which provides both a framework for budget and tax legislation to follow this year and a broader fiscal policy blueprint for the next ten years, lays out an exceedingly harsh vision for the nation. It would cause pain to tens of millions of Americans, especially struggling families and others who have fallen on hard times, and would cut deeply into areas important to future economic growth, from education to basic scientific research. It would do so while opening the door for tax cuts geared toward those who already are the most well off.
The plan proposes to cut "$4.4 trillion over ten years from entitlement programs, including cuts to Medicaid and Medicare, income assistance for working-poor and other struggling families, basic food assistance, and assistance for students to go to college." It cuts $1.3 trillion from programs like "job training and education, scientific and medical research, environmental protection, basic operations of the Social Security system, and efforts to protect public health. Overall funding for this part of the budget has already fallen significantly since 2010…but this budget would slash it much further. By 2027, [such] funding would be 44 percent below its 2010 level, after adjusting for inflation, and — measured as a share of the economy — spending on this area of the budget would fall to its lowest level since before the Great Depression."
So the enlightened path clearly still eludes many of these policymakers.
Still, has there been a disturbance in the force? A chink in some of their armor that heretofore has precluded any cognitive dissonance from breaking through?
Maybe; maybe not. Too soon to tell. But this would be a good time for those of us who recognize a role for government in insuring against risk (including health risks), providing opportunities for the poor, offsetting market failures, ensuring retirement security, protecting the environment, maintaining productive public goods, pushing for racial justice, and promoting full employment to press our advantage. There's a vacuum out there, folks, and whomever fills it deserves our support.
