Well, it finally happened.
Donald Trump made his long-awaited pivot, and truly became a Republican this week. His spokesman, Sean Spicer, cast off any notion of daylight between the White House and the Obamacare “repeal and replace” bill put forward by the House once it was released from its secret basement birthing room and rushed through the Ways and Means committee at 4:30 Thursday morning on a party line vote. Spicer said the president is in “sell mode” for the plan. That means Team Trump now fully owns this mess—let’s call it TRyancare, a name as unwieldy as the plan itself—alongside the Republican Party.
It clearly doesn’t matter to Trump or to the drafters of the draconian bill, adorably named the American Health Care Act so that it sounds almost exactly like the Affordable Care Act, that it breaks every promise the president made to his supporters on the campaign trail. Or that it can only loosely be called a “health care plan,” because it actually reduces health care for the poor, the working class, rural hospitals, and the elderly to pay for a massive tax cut for the rich and large corporations and hands an extra $70 million or so a year to health insurance company CEOs. Or that the analysts at S&P Global Ratings estimate that Paul Ryan’s Rosemary’s baby will strip health care from 6 to 10 million Americans right off the bat. Or that pretty much everyone on Capitol Hill hates it. Trump sees the opportunity to demonstrate his “art of the deal” skills—perhaps he’ll finally get around to reading the book about it that Tony Schwartz ghostwrote for him—and so it’s time to sell, sell, sell!
Perhaps Trump can use Spicer’s trick and explain to all those coal miners who Paul Ryan wants to leave without coverage for black-lung disease that the bill is awesome because it prints out in a really short stack. Or maybe he can just scream “Planned Parenthood!” at some more “thank you rallies” to get the church people worked up in favor of TRyancare.
However he sells it, by fully backing Ryan’s bill, Trump has signed onto a Republican dream that’s older than he is—of stopping or killing universal health care and nearly every other form of federal assistance to the needy.
Republicans fought tooth and nail to stop FDR from enacting Social Security, even likening it to slavery (or as Ben Carson sees it, alt-immigration) though in the end most of them wound up voting for it.
The American medical lobby fought against the creation of Medicare and Medicaid, backed by conservative Republicans like Barry Goldwater and then-actor Ronald Reagan, who in 1961 called those programs “socialized medicine” that would be the death knell of freedom.
At the root of Republican opposition to federal government aid to the poor and the elderly is a proposition that Paul Ryan telegraphs every time he opens his mouth and fixes his soulless eyes on the cameras. Ryan and his ilk, as he explained in his chart-filled presentation Thursday, believe it is wrong; a moral hazard no less, to make healthy people pay for sick people’s health care—which not so incidentally is how insurance works—or to tax wealthier people to pay for benefits for poorer folks.
They believe that the federal government’s only responsibility is to ensure robust overall economic growth, which in their view is accomplished through tax cuts for the super-rich and big businesses. After that, each member of society must figure out on their own how to make that growth work for them. If they can’t, either because their rich employers won’t pay them a decent wage or they lose their job, then in the view of the economic Darwinists who control the Republican Party’s establishment, libertarian and tea party wings, it should be private and religious charities, and not the taxpayer, that step in to help those who many on the right view as mostly lazy drug addicts and “illegals” dreaming of American welfare.
Conservative guru Barry Goldwater, talking about Medicare and Medicaid in 1964, famously said: “Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink?”
Today’s Republicans, from the full-on “let granny die in the E.R.” repealers to the “hand granny a voucher and wish her the best of luck” replacers, have been guided by this core philosophy since the party morphed from one of freedom for the enslaved under Abraham Lincoln to one of freedom for the super rich from the burdens of taxation, regulation or caring in any way for the poor under Calvin Coolidge. No matter how today’s Republicans talk about a fictional ACA “death spiral,” they are soldiers in the same long war not on poverty but on the poor.
Thanks to nearly 40 years of right-wing talk radio, Republicans have been able to convince their base, even the poorest among them, of the general rightness of this philosophy. But what Donald Trump exposed during the Republican primaries is that base Republicans have never been fully on board. Instead, what Trumpism revealed is that the GOP base believes the government should absolutely help those who are down on their luck; it’s just that they want the feds to limit that assistance to those the Trumpists deem “worthy”—to “real” Americans, like them. They wholeheartedly believe in what we errantly call “entitlements”—they just want them withheld from immigrants and others (read: minorities) they consider to be stealing from them.
Trump promised these people he and Republicans would repeal Obamacare and replace it with “something terrific” that would not let people (read: them) “die in the street.” But apparently, Steve Bannon and the white nationalist kakistocrats running the White House forgot to let Paul Ryan in on that part of the plan—or maybe they left him dangling on purpose, so he’d take the fall.
That leaves Republicans fighting amongst themselves over whether their “repeal and replace” bill is too blatantly cruel to get them re-elected (see: Rob Portman of Ohio, Colorado’s Cory Gardner, Shelley Moore Capito of West Virginia, Tom Cotton of Arkansas, and Lisa Murkowski of Alaska); or not nearly cruel enough (Rand Paul, the House “freedom caucus,” Bannon alumni association Breitbart.com, the Tea Party, the Koch brothers, and the right-wing think tanks, who want the entire HCA torn out root and branch, pre-existing conditions rules included). Still others, led by Jason Chaffetz, are just scrambling to stop embarrassing themselves on television while explaining the bill. For Ryan, the best course of action is to ram through his House bill before even more Republicans get cold feet.
So here’s the answer for those who’ve wondered why Speaker Ryan has been wearing that empty-eyed MAGA grin since last fall. It’s because he and his Ayn Randian fellow travelers view Trump the same way Steve Bannon does: as merely the vehicle by which their long-desired plans can be enacted.
Just as Bannon foresees Trump’s name affixed to his dream of turning the United States into a 1930s style hypernationalist Christian ethnostate; in Ryan’s vision, it is Trump whose signature enacts Ryan’s dream of repealing the 20th century. In the Ryan dreamscape, Trump’s tiny hands will sign the bills that extinguish not just Obamacare, but also Medicare, Medicaid, and maybe even Social Security. And then Trump will be the one to convince the restless white working class that gutting the safety net was good; or at least that the bread and circuses—the persecution of immigrants, Muslims, trans teens, and black people unfolding on Fox News and on their Facebook feeds, and the wall springing up along the southern border, albeit paid for by American taxpayers—makes the pain of losing their health care or going bankrupt paying for emergency surgery worth it.
And now, Donald Trump is on board with Ryan’s sales plan.
So we’ll soon find out whether the Republican base—which is absolutely devoted to Donald Trump, seemingly no matter what he does (75 percent of Republicans in the latest Quinnipiac poll strongly approve of his performance while majorities of every other group disapprove)—is so besotted that they are prepared to sacrifice their own health and that of their children and their elderly parents for his cause.
Republicans had better hope so. Because whatever comes of this shambolic process of repealing and replacing Obamacare, and however loudly some GOPers protest that they simply want to save social insurance programs from the horrors of increased funding by Democrats, Republicans are in this TRyancare mess together.