Because Republicans have no governing vision, they can’t replace President Barack Obama’s vision for health care with a good alternative. They just accept the basic structure of Obamacare and cut it back some.
ASPEN, Colo. — There is a structural flaw in modern capitalism. Tremendous income gains are going to those in the top 20 percent, but prospects are diminishing for those in the middle and working classes. This gigantic trend widens inequality, exacerbates social segmentation, fuels distrust and led to Donald Trump.
Conservative intellectuals were slow to understanding the seriousness of this structural problem, but over the past few years they have begun to grapple with the consequences. Basically, many conservative intellectuals have come to terms with income redistribution.
Conservative income redistribution doesn’t look like liberal redistribution. Conservatives tend to like their redistribution done at the local level, and they like to use market-friendly mechanisms, like child tax credits, mobility vouchers and wage subsidies. But the intent is the same: to give those who are struggling more security and opportunity.
Conservative redistribution extends to health care. Over the past several years many plans have emerged from the various right-leaning thinking tanks that imagine consumer-driven health care that also has universal or near universal coverage.
These plans, from places like the American Enterprise Institute, use tax credits or pre-funded health savings accounts or some other method to give middle- and working-class people coverage, while reducing regulations and improving incentives throughout the system.
Republican politicians could have picked up one of these plans when they set out to repeal Obamacare. They could have created a better system that did not punish the poor. But there are two crucial differences between the conservative policy johnnies and Republican politicians.
First, conservative policy intellectuals tend to have accepted the fact that American society is coming apart and that measures need to be taken to assist the working class. Republican politicians show no awareness of this fact. Second, conservative writers and intellectuals have a vision for how they want American society to be in the 21st century. Republican politicians have a vision of how they want American government to be in the 21st century.
Republican politicians believe that government should tax people less. The Senate bill would eliminate the 3.8 percent tax on investment income for those making over $250,000. Republican politicians believe that open-ended entitlements should be cut. The Senate health care plan would throw 15 million people off Medicaid, according to the Congressional Budget Office. (This is the program that covers nearly 40 percent of America’s children.)
Is there a vision of society underlying those choices? Not really. Most political parties define their vision of the role of government around their vision of the sort of country they would like to create. The current Republican Party has iron, dogmatic rules about the role of government, but no vision about America.
Because Republicans have no governing vision, they can’t really replace the Obama vision with some alternative. They just accept the basic structure of Obamacare and cut it back some.
Because Republicans have no governing vision, they can’t argue for their plans. Health and Human Services Secretary Tom Price came to the Aspen Ideas Festival to make the case for the GOP approach. It’s not that he had bad arguments; he had no arguments, no vision for the sort of health care system these bills would usher in. He filled his time by rising to a level of vapid generality that was utterly detached from the choices in the actual legislation.
Because Republicans have no national vision, they seem largely uninterested in the actual effects their legislation would have on the country at large. This Senate bill would be completely unworkable because anybody with half a brain would get insurance only when they got sick.
Worse, this bill takes all the devastating trends afflicting the middle and working classes — all the instability, all the struggle and pain — and it makes them worse. As the CBO indicated, the Senate plan would throw 22 million people off the insurance rolls. It would send them to private insurance plans that they could not afford to buy. Under the Senate bill, deductibles for poor families would be more than half of their annual income. The plans are so incompetently and cruelly designed that as the CBO put it, “few low-income people would purchase any plan.”
This is not a conservative vision of American society. It’s a vision rendered cruel by its obliviousness. I have been trying to think about the underlying mentality that now governs the Republican political class. The best I can do is the atomistic mentality described by Alexis de Tocqueville long ago: “They owe nothing to any man, they expect nothing from any man; they acquire the habit of always considering themselves as standing alone, and they are apt to imagine that their whole destiny is in their own hands.
“Thus not only does democracy make every man forget his ancestors, but it hides his descendants and separates his contemporaries from him; it throws him back forever upon himself alone and threatens in the end to confine him entirely within the solitude of his own heart.”