Republicans get mean on Obamacare

The Republican party is close to reaching its goal of obliterating Obamacare. They just have to keep President Donald Trump under control for long enough to get their bill through the Senate.

When President Donald Trump said“nobody knew healthcare could be so complicated” it was a statement that was both endearing and scary.

He displayed a vulnerability career politicians rarely do, that he had stumbled into an area the average man finds notoriously confusing. There was part of you that was worried a leader of the US had such a fundamental lack of understanding of such an important issue. Perhaps it was an admission by a billionaire who has never had to worry about his healthcare bills.

Yet Trump was elected on a simple promise to abolish the health system and health insurance structure introduced by Barack Obama known as ‘Obamacare’. So he must persist.

Trump was an opponent even before he was a presidential candidate.

On Thursday Senate Republicans gave us some idea of the latest plan to bring order to the American healthcare system. We were assured the hated (hated by Republicans anyway) Obamacare would be dead by next week.

The ideological battleground the Republicans have chosen to finally obliterate President Barack Obama’s legacy is healthcare (Obamacare). 

Obamacare sought to bring "affordable, quality health insurance and to reduce the growth in US healthcare spending."

The US spends over $3 trillion a year on healthcare.

Republicans believe they can have a health system with "heart" (Trump’s words), but they must please key sections of their voter base while they’re at it.

Only President Trump, a man unschooled in politics, made an unholy mess of the Republican’s early efforts to get rid of Obamacare. In March the Republican’s American Health Care Act 2017 had to be withdrawn because Leader of the House Paul Ryan believed they didn’t have enough votes.

Trump’s rush to push through a complicated bill too early and his rookie political efforts to negotiate on Capitol Hill were blamed.

Last month the Republicans passed their ‘repeal and replace’ bill by a slim 217-213 in the House of Representatives. It was leaked that President Trump had, behind closed doors, slammed it as "mean."

So as the opportunity to pass an amended bill through the Senate approaches the Republican leader in that chamber, Mitch McConnell, chose to keep his cards close to his chest. There was total secrecy around the contents of the bill until Thursday. This was to allow the Senate strategists to get it through and bargain for backing. But it also served to keep Trump’s White House in the dark. Trump, after his embarrassing setback in March, seems to have allowed this to ensure a victory.

Trump is trumpeting the bill, but he is staying well away from the backroom negotiations this time. He wants a win, and he wants to humiliate the Democrats.

The wealthy and the young will benefit in comparison to how they would have fared under Obamacare. Those suffering from addiction and those who favor planned pregnancies will not fare so well.

Healthcare is an ideological battleground in the US in a way that is not seen elsewhere.

The British get many things wrong, but one area where they are widely admired is the successful introduction of their National Health Service (NHS). In 1945 the British electorate thanked Winston Churchill for his role in winning the war by booting him out of office. Labour’s Clement Attlee got in and set about introducing adequate healthcare for all.

When the Conservatives got back in, they kept it. The Tories understood that people liked it and the whole healthcare thing is too complicated to tear up repeatedly. And anyway, deep down the Tories will accept a bit of socialism if it wins them votes.

Just 90 miles off the coast of America Communist Cuba can’t get much right. But it has what is regarded the world’s best health service.

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Senate Republicans release draft of Obamacare repeal-and-replace bill

The provision of universal healthcare and adequate health insurance are issues that have dogged all developed countries since the war. Firstly to provide a universal healthcare system that covers all is bound to be difficult a child of three and an adult of 80 have vastly different requirements. And so does everybody else in between. With the provision of better healthcare, populations get older, so needs change again.

Any effort to impose pure free market economics on healthcare insurance is doomed to fail because it is an essential requirement the young must pay more to help provide adequate healthcare for the elderly. Obviously, the provision of health for the elderly being so much more expensive.

And still, central government has to contribute.

Throw deep ideological division on this intractable issue, and you’ve got a real mess, as you do in the US right now.

Ideological divisions in the US have deepened, not dissipated since Franklin D Roosevelt’s New Deal in the 1930s. His efforts to bring some form of state protection for the most vulnerable in society were condemned as socialism then. And efforts such as Obamacare have been condemned as such since.

President Trump’s predecessor Barack Obama sought to help the poorest in society with his Obamacare.

I’m going to oversimplify here. The Democrats are historically more associated with the descendants of immigrants and the poorer sections of American society. The party believes in bigger government. Republicans’ are adherents to free market economics and will oppose anything that smells like socialism. A great proportion of Republican voters is made up of higher income earners.

Since the Obamacare Affordable Care Act (ACA) was passed in 2010, Republicans have vowed to tear it up. Now they are in the White House and control the House and the Senate. Trump, on the campaign trail, promised he’d get rid of it. Easy.

Only Trump confused things again.

The post-election analysis showed many of the poorer white working classes had voted for him. And they had benefited from Obamacare’s increased protection for the poor.

Trump wants to see the white working classes of the Rust Belt kept within his tent. Yet it is the wealthy and generous donors who must be kept happiest in the Republican world.

So some deft political footwork was required. And that is not Trump’s forte.

The bill that will go to the Senate next week, the Better Care Reconciliation Act 2017 will at once abolish hundreds of millions of dollars in taxes on the wealthy and the health industry.

It will also stop an expansion of an Obamacare scheme known as Medicaid, a federally-funded healthcare assistance scheme for the less well-off.

But it will keep Obamacare's insurance subsidies to help low-income people buy insurance.

It doesn’t impose any new requirement that people purchase or maintain coverage — a major element that Republican leaders said they’re still working on.

There are also plans under the draft bill to remove funding for schemes that cover planned parenthood. But this provision may not be allowed under Senate rules.

The Senate bill will allow states opt out of Obamacare insurance requirements. It will, however, carry a key change from the House bill – it will not discriminate against those with pre-existing conditions.

Trump is backing all of this with his usual vigor, but he is staying out of Capitol Hill bargaining.

Thus far he has not been reported as condemning it as "mean." But Democrats have a gone a step further, calling the bill "meaner."

Republicans amended Obamacare 60 times as it slowly wound its way through Congress.

And still the ideological battles go on.

Freedomworks, a conservative advocacy group, said the new bill is merely "an amendment to Obamacare."

Four Republicans Senators Ted Cruz, Ron Johnson, Mike Lee and Rand Paul believe the bill does not go far enough in repealing Obamacare and are holding out. So the Republicans still do not have the 50 votes required to pass the legislation.

It looks like healthcare will continue to be an ideological battleground where the sick will continue to be the vanquished.