OK. It's time to try to pull everything together on the Red States, the Republican Party, ObamaCare, "repeal and replace", and starting at the top of the evil tree and hitting every branch all the way down...
Let's start with a catch from Austin Frakt last January:
Austin Frakt: These two tweets tell you all you need to know about the politics of health reform: January 29, 2014 at 12:30 pm: Two of Avik Roy’s tweets yesterday...
...pertaining to the recently released Senate GOP health reform plan (the Patient CARE Act [of Burr (R-NC) Coburn (R-OK), and Hatch [R-UT) and discussion thereof, are very revealing.
@matthewherper: @Avik it still seems to me that this is going to hit a lot of voters harder. Even if it makes economic sense.
@Avik: .@matthewherper By repealing and replacing Ocare, the plan is more disruptive than it needs to be. But repeal needed for Right viability.
And, of course, it had no right-wing viability at all even so.
Their plan was to deliver a couple of major tweaks to ObamaCare--but in the process to tear down a bunch of existing mechanisms and bureaucracies in ObamaCare and then build new ones made for inefficiencies. It was, as Avik Roy says, not "repeal and replace"--although it was framed that way. But those inefficiencies that made it a technocratic non-starter. The resulting pointless churning in the health insurance market with a very large number of people losing their plans made it a political non-starter. The grinchiness of the supported benefits levels made it a social-insurance non-starter.
And with all of that they did not get any right-wing viability.
You see, Boehner and McConnell--and if not them, certainly Burr, Coburn, Hatch, Voinovich, Snowe, and Collins--should have declared victory on health care in the fall of 2009, when Obama dropped the public option and put Nationwide RomneyCare forward as ObamaCare. They should have said that they had faced the president down, got him to accede what McCain would have proposed had McCain won the presidential election, and that this was a victory for good Republican governance and common-sense--a Republican, not a Democratic policy victory.
The problem from Boehner and McConnell's perspective, however, was that to tell that story was also to tell the story that the president was a sensible guy with centrist leanings who you could negotiate with. And they did not dare tell their base not for fear that the money and the phone-bank hours would stop flowing. Instead, they needed the base terrified of Kenyan Muslim Socialism. And so where RomneyCare had been a much-needed restructuring of health-care regulation so that the fee market could work, ObamaCare became a socialist government takeover of the health-care sector that had to be repealed root-and-branch before you could even begin to talk. Never mind that to two significant figures ObamaCare = RomneyCare
Thus, of course, where the rubber hits the road Burr, Coburn, and Hatch do not want to repeal ObamaCare: it is close to what they want to do. But they cannot admit that it is close. And so they cannot even propose what they really want to do--when they try, they abandon their own plan and run for the hills within 72 hours.
Similarly, at the state level the Red State governments found themselves trapped in a horrible box by John Roberts's lawless Sibelius Medicaid expansion decision. They could accept the Medicaid expansion--and so cooperate with the Kenyan Muslim Socialismization of America, and see their base turn against them. They could reject the Medicaid expansion--and see their rural safety-net hospitals close as the DPS payments to hospitals for treating the uninsured were phased-out, see a bunch of their citizens excluded from the system's subsidies while the subsidies flow to immigrants with green cards, still have to cost-shift to somehow raise funds to treat the poor while blue states can rationalize payments, and see their economies shrink relative to baseline by perhaps four percent per the next decade because they dare not be complicit in ObamaCare and because Roberts did not understand the law he was rewriting from the bench.
But what is the chance that they turn around and tell their base: "We lied to you. ObamaCare is not such a disaster after all"?
I must confess that I have some affection for Ronald Reagan. He really tried to do the right thing. And he was willing to conclude that when one group of advisors' plans had not worked out it was time for different advisors. Plus there was that moment when a gang of misfits--an astrologer, a first-lady, and a slightly-Alzheimer's addled president--set out to end the Cold War and try to rid the world of nuclear weapons. But did Ronald Reagan ever admit he had lied when he said that if Medicare passed:
we will awake to find that we have socialism. And... one of these days, you and I are going to spend our sunset years telling our children, and our children's children, what it once was like in America when men were free...
Did Herbert Hoover ever admit he had lied when he said that although Social Security:
may produce an efficient economic or Governmental unit by a manufactured, regimented, imposed environment... you will not produce a free individual... you will not produce an American.... Economic security... we can find in our jails. The slaves had it. Our people are not ready to be turned into a National zoo... classified, labelled, and directed by a form of self-approved keepers....
They must be taught not to change their souls and spirits for the fallacious promises of material comforts... in such an exchange the individual finds himself robbed of all, both spiritually and materially.... Merely to feed, clothe, and house the unemployed and the unemployable... could [be] do[ne] by the simple methods of bread lines, barracks, and dungarees.... If we stifle the freedom of spirit which builded our productivity we shall be distributing poverty instead of distributing plenty.
Scott Lemieux: Red States Inflict Suffering on Their Citizens to Spite Obama "The most direct consequence of states refusing to accept the Medicaid expansion is people suffering...
...because they don’t have medical insurance. The problems are going beyond this as well:
While record numbers of Americans sign up for the larger Medicaid health insurance program for the poor, financial issues are emerging for medical care providers in the two dozen states that didn’t go along with the expansion under the Affordable Care Act.... he moves against expansion are 'beginning to hurt hospitals in states that opted out', a report last week from Fitch Ratings said.... 'We expect providers in states that have chosen not to participate in expanded Medicaid eligibility to face increasing financial challenges in 2014 and beyond. Nonprofit hospitals and healthcare systems in states that have expanded their Medicaid coverage under the Patient Protection and Affordable Care Act have begun to realize the benefit from increased insurance coverage'....
Although the Medicaid portions of Sebelius used exceedingly unpersuasive reasoning to produce a horrible outcome... the states remain free to take the expansion. The fact that Republican-controlled ones generally aren’t tells you everything you need to know about the contemporary Republican Party.
I must say that as I look forward to having my base of operations here in the Lower Missouri Valley for the next three months, my big task is going to maintain my political equilibrium (such as it is). Berkeley tends to slowly and gradually push me toward being a domestic-policy neoconservative. But three months from now it will be a miracle if I am not a Trotskyist.
"Awesome in its evilness" was how Jon Gruber characterized the Republican power structure that now surrounds me...