Republicans Get a Taste of Their Own Medicine

Was that a great thing to watch or what? Here was Paul Ryan, who made the hubristic mistake of trying to pass a bill on the seventh anniversary of Obamacare for symbolism’s sake before he had the votes. There was Donald Trump, who could say nothing reassuring about substance to House Republicans when he met with them this week because he has no grasp of the substance.

Boy, did they get what they deserved. It’s a momentous defeat for both of them. Trump has been promising repeal of Obamacare for nearly two years now; Ryan, for seven. But this didn’t happen because of their tactical mistakes this week. This happened for two reasons.

Reason number one: the lie that’s been buried in Republican arguments against Obamacare since the beginning. The lie is that Republicans said they would keep the good parts of the Affordable Care Act and get rid of the bad, or “bad.” But you can’t. You can’t. You can’t make insurers offer coverage to people with pre-existing conditions without also having some kind of individual mandate to buy insurance.

Let me repeat that, because it’s what this is all about. You can’t make insurers offer coverage to people with pre-existing conditions without also having some kind of individual mandate to buy insurance. Put another way: You can’t force insurers to cover sick people without bringing more healthy people into the insurance pool. Healthy people help bring down costs. Healthy people pay for sick people. Paul Ryan absurdly called this Obamacare’s “fatal conceit” the other day, which makes him either a fool or liar.

And then, to extend it out further: You can’t force healthy individuals to buy insurance without having some kind of subsidies. Some healthy people don’t buy insurance because they’re healthy and they think they don’t need it. But most healthy people who don’t buy insurance don’t buy it because they can’t afford it. So you have to do something to make them able to afford it. Hence subsidies.

But in Republican-Ryanesque-Randian ideology, the individual mandate was evil, and the subsidies of course were horrendous. So they absolutely had to go. But, Republicans promised, we’ll keep the pre-existing conditions thing, because people like that! And we don’t want to look heartless.

But it is impossible to keep that without the other two “legs of the stool,” in the parlance. Impossible. I give the Freedom Caucus people this much credit: They at least were honest enough to say hey, we don’t mind seeming heartless at all—we want to get rid of the pre-existing conditions thing too! But that wasn’t something leadership could embrace politically. So Ryan and all the Republican leaders have been peddling a lie to the American people for seven years, telling them they could have this wonderful thing and could have it for free. Conservatives are supposed to know better than liberals that nothing is free.

And that’s the main reason this bill collapsed. It’s impossible to do what they said they could do. So it was completely unsurprising when the Congressional Budget Office said, in essence, uh, guys, you can’t give people this thing that isn’t free for free.

So that’s number one. Number one, I knew, I’ve known for years; but nothing special about me—everyone with a brain who looked at the matter honestly and non-ideologically knew that this was the case. Number two was a surprise, even to me—the lightning turnaround over these last few weeks in Obamacare’s numbers.

Have a gander at this HuffPo Pollster chart. Obamacare had positive numbers right when it was introduced in early 2009, but it went into the red that July and stayed there for seven-plus years. It was roughly -10 the day it was signed into law. It bottomed out at -16 in early 2014. It climbed over the next two years but was still a tad underwater last Election Day.

Then, late last year, after the election and as repeal became a very real prospect, its numbers started to go up. And now, HuffPo has it about +5. Still not great—but a world of difference. If it were still -16, this would have been an easy lift for Republicans.

But worse still for Republicans were the polls showing that while people were still mixed on Obamacare, they firmly did not want this repeal. That Quinnipiac poll the other day that put support for repeal at 17 percent was a dagger. Our democracy may be corrupted, but it’s still enough of a democracy that something with 17 percent support is not going to pass.

And so Ryan admitted at his press conference that “we are going to be living with Obamacare for the foreseeable future.” They might try again someday. The Trump administration, notably its Health and Human Services Department, will try to do everything it can to make it fail. But insurers, doctors, and hospitals will now adapt to reality. And who knows, maybe even a few more Republican governors will, too. Each new state that takes the Medicaid money is one more arrow in repeal’s heart.

Trump and his HHS can do damage. But I think they can only do so much. Undoing Obamacare takes Congress. And Congress will be no more equipped to do it a year from now than it was now, because what the Republicans want to do is impossible. They had seven years to come up with a replacement bill that they could all agree on. Why didn’t they? Because their replacement bill was always from the land of make believe.

Mr. Rogers said that. He also said it’s a beautiful day in the neighborhood. Yes. It sure is.