The old Superman comic books used to feature a character named Bizarro,
who looked exactly like the Man of Steel, except for his blocky,
Frankenstein-like features and the fact that everything about him
.
Whereas Superman could burn things with his eyes, the lumbering Bizarro
could freeze them; while Superman’s X-ray vision couldn’t handle lead,
Bizarro’s could penetrate
lead. You get the idea.
That’s the image that kept popping into my head this week as I watched Republicans
toward an ill-conceived overhaul of the health care system. In a sense,
what Republican leaders are frantically trying to push through Congress
is the Bizarro health care plan — a mirror image of the law it would
replace, patched together from spare parts and castoff ideas.
They now seem bent on making exactly the same mistakes Democrats did in 2009, but in exactly the inverse way.
At about this time eight years ago, I was
hanging around Capitol Hill and the White House, putting together a
preview of the looming health care fight for the New York Times
Magazine. (The piece
holds up pretty well, I think, but judge for yourself.)
The pivotal Democrat on the Hill then was Max
Baucus, the Montana senator — and later President Obama’s ambassador to
China — who chaired the Senate Finance Committee. Like Obama, Baucus
thought CEOs, health care providers and politicians who had once opposed
reform could now be persuaded to support it, as long as the plan
promised to get soaring costs and federal spending under control.
And Baucus told me that any new law had to
have at least some measure of bipartisan support, even if that required
painful compromises. That’s because no piece of massive social
legislation had ever been perfect from the start, and in order to
preserve and fix it, you needed at least a few members of the minority
to be invested in its success.
A transformational law of this size, Baucus said, would be “unsustainable” if one party decided to enact it alone.
The
problem for Baucus was that most Democrats, especially in the House,
didn’t care at all about corporate competitiveness and public debt. They
cared about bringing down the number of poorer Americans who couldn’t
afford insurance, and they weren’t open to painful fiscal choices in
order to get that done.
So while Obama and his congressional allies
sold their plan to industry and the public as an economically necessary
reform that would “bend the cost curve,” the law they ultimately passed
was really more a wealth transfer program that birthed new regulations
and taxes in exchange for expanded coverage for the poor and some
middle-class protections — a program very much in the tradition of the
Great Society.
The most
difficult decisions
involving public spending were pushed off years into the future, for
some other group of politicians to worry about. And of course, as it
turned out, Democrats ended up passing the law along strictly partisan
lines, using a budgetary gimmick known as “reconciliation” to help it
along.
This wasn’t their call, to be fair; they
really weren’t given a whole lot of choice. But what all of this meant,
practically speaking, is that Baucus was right — the law was probably
politically unsustainable from the start.
What came to be known as “Obamacare” was
wildly successful in reducing the number of uninsured Americans by more
than 20 million, but the public saw little of the economic benefit it
was promised. (Although in truth, health care costs have risen more
slowly than they might have otherwise.) Democrats couldn’t make
necessary fixes in the sprawling law, because no one on the Republican
side had any interest in seeing the law fixed.
Jump ahead now to where congressional
Republicans are this week with their American Health Care Act — which is
precisely the upside-down version of where Democrats were eight years
ago. Whereas Democrats took a bill that was principally about expanding
health care and dressed it up as an economic measure, Republicans are
taking a plan that’s almost entirely about economics and pretending it
has something to do with health care.
They may advertise their bill as a
market-based solution to health care inequities, but in fact, what
Republicans really care about right now is shedding the new revenue and
spending in Obama’s health care law — specifically by repealing taxes
and eliminating subsidies for the poor and the Medicaid expansion in the
states.
President Trump has promised that “you’ll see
rates go down, down, down and you’ll see plans go up, up, up,” and, in
distinctly Trumpian terms, that the new system will be “a thing of
beauty.”
But the Congressional Budget Office, which is
led by a Republican appointee and has a slightly better record than
Trump when it comes to veracity, estimates that the plan will cost 24
million Americans their health insurance while saving the government
more than $300 billion over the next 10 years.
This time there’s not even a question of
bipartisanship. Republicans have been plotting a three-stage legislative
process, including a reconciliation measure of their own, to pass their
plan without a single Democratic vote — although it’s becoming
increasingly unlikely that they will settle anytime soon on a plan that
wins over both House conservatives and Senate moderates.
The problem — especially if you’re one of
those moderates who actually care about governing and have to get
elected statewide — is that the Bizarro health care bill wouldn’t be any
more lasting than its predecessor.
Before long, the public would figure out that
the law isn’t going to do anything to make coverage more affordable or
the choices more vast, as promised, but rather the opposite. Eventually,
the popular protections that Republicans say they’ll keep are likely to
become unworkable without mandates and subsidies.
Mostly
the bill would spare some small businesses and wealthier Americans from
paying additional taxes and cut back the Medicaid rolls. The issue of
what to do about the uninsured would roar back into the public debate.
And good luck trying to amend the bill in
ways that would mitigate its harshest effects, because Democrats may
well gain seats in the ensuing elections, and they’re not going to feel
the slightest motivation to help clean up the mess.
In some ways, Republicans are in a more
precarious position with the Bizarro bill than Democrats were in 2009.
Obama, at least, managed to cobble together support from insurers and
providers, which muted some of the criticism when premiums started to
rise. Trump and Paul Ryan, the House speaker, haven’t even tried to
assemble a coalition.
You have to remember, too, that Republicans
are playing with something here that neither party has ever attempted on
such a scale before: a rollback of benefits the public already has.
It’s one thing to ram through a program with lots of subsidies and new
rights attached. It’s an untested proposition to unilaterally take that
stuff away.
Here’s what we do know: With a policy area as
complicated as this one, and as reliant on theories about how the
markets and consumers will respond to various incentives, you’re never
going to pass one law and be done with it. Responsible governing in
Washington — if we can still conceive of such a thing — means being able
and willing to reassess and adjust to reality as time goes on.
Democrats were never going to be able to do
that because of the dubious ways in which they sold and enacted their
law. And Republicans won’t have that option, either, even if they manage
to come up with something that satisfies their dueling factions.
Superman and Bizarro never actually resolve anything. They just retreat to their parallel universes and live to fight again.
by MATT BAI
