How Obamacare repeal sets the table for the entire GOP agenda

President-elect Donald Trump and his Republican allies in Congress are ready to press ahead with Obamacare repeal come January.  The effects of repeal will be devastating enough.  But repeal also triggers problems that help the GOP justify the rest of its agenda.  By repealing Obamacare, Paul Ryan and company will try to bootstrap in drastic changes across government in the name of reducing deficits and stabilizing federal programs like Medicare.

Republican plans to repeal Obamacare would exact a massive human toll.  Repeal could throw upwards of 30 million people off of their health insurance, doubling the current uninsured rate.  And if Republicans gut the law’s protections for those with pre-existing conditions, 52 million people would struggle to find affordable insurance.

The human carnage of repeal is meant to coerce Democrats into going along with a right-wing replacement bill.  Republicans will have 52 votes in the Senate in 2017.  They can repeal most of Obamacare with 51 votes for a reconciliation bill.  But to enact new legislation replacing the law, they’ll need eight Democratic votes to overcome a filibuster.  The thinking is that creating an Obamacare cliff with massive human disaster on the other side will compel cooperation from Democrats.

Never mind whether this scheme can actually work without provoking a stampede of insurers out of Obamacare’s marketplaces during the transition period leading up to the cliff.  Like the hostage-taking expeditions during the Obama administration—the debt ceiling fiasco, the fiscal cliff, the government shutdown—this is another instance of the GOP manufacturing a crisis in order to strong-arm its policy priorities through Congress.

Conveniently for Republicans, Obamacare repeal opens the door to far more of the conservative agenda than just upending the individual insurance market.  According to a new report from the Brookings Institute, repeal would also jeopardize the solvency of Medicare.  Obamacare included a 0.9 percent payroll tax on incomes above $200,000 to help shore up Medicare’s finances.  This extended the solvency of the program’s trust fund until at least 2028.  Without this tax, Medicare could go broke in less than eight years.

It’s impossible to imagine conservatives restoring any of Obamacare’s taxes on the wealthy.  (Indeed, cutting these taxes is part of the appeal of Obamacare repeal for Republicans.)  And by repealing the law, Republicans also drag Medicare closer to crisis.  It’s easy to picture Ryan and others seizing the opportunity to warn that Medicare cannot be sustained without drastic changes along conservative lines–the type of reform Ryan has spent years pursuing.  The conservative vision would terminate our commitment to Medicare as a government-run insurance plan, and replace it with a voucher payment to seniors to shop on their own for private insurance plans.

So by repealing Obamacare, Republicans worsen Medicare’s financial position and thereby tee up the case for privatization.  But that’s not all.  The passage of Obamacare has corresponded with a marked slowdown in the growth of healthcare costs over the last several years.  The U.S. is currently on pace to spend $2.6 trillion less on healthcare than we expected before Obamacare was passed.  It’s difficult to assess how much Obamacare contributed to these savings, but it undoubtedly played a part.

If this slowdown is reversed by repeal, and healthcare costs begin to balloon again, the GOP could well use it as an excuse to pass the rest of its radical policy prescription across the entire gamut of American insurance options.  These reforms range from block-granting Medicaid to capping the tax exclusion for employer-provided insurance to promoting higher deductibles for more people.

Repeal could even give Republicans space to shoehorn in their desired policies outside of healthcare.  The Brookings report also found that Obamacare repeal will worsen long-term deficits.  Republicans will also undoubtedly pursue massive tax cuts near simultaneously with Obamacare repeal.  This combination will cause deficits to explode.  And as the Congressional Budget Office begins projecting larger and larger deficits, Republicans will have a ready-made excuse to justify austerity politics and massive cuts to safety net programs and other domestic spending.

We’ve seen this story before: the GOP leverages a crisis of its own making to push through its chosen policy prescriptions.  Even with a congressional majority, Republicans won’t be able to quit governing through crisis mode.  Their policy agenda will be painful for millions of Americans, and deeply unpopular because of it.  Republicans need a pretext to bolster the political necessity for making sweeping changes to our safety net.  Repealing Obamacare unlocks a whole host of rationales to help the GOP do precisely that.

But this also allows Democrats and other Obamacare defenders to lay out the full stakes of repeal.  Obamacare repeal doesn’t just rob insurance from the millions who have gained coverage under the law.  Repeal also jeopardizes the financial sustainability of Medicare for future retirees.  Repeal threatens to ignite higher healthcare inflation, raising premiums and eroding employees’ take-home pay.  Repeal erodes the financial standing of a whole host of programs for low-income Americans that are vulnerable to arbitrary budget cuts.  The implications of repeal are simply massive.

By repealing Obamacare, the GOP is trying to tee up its entire legislative agenda.  Liberals have an obligation to shout from the mountaintops about the full harm of this conservative exercise in bootstrapping.

Conservatism’s working class blues

In 2004, Thomas Frank set off a firestorm of debate with his book What’s the Matter with Kansas? He explored the question of why working-class white voters in America’s heartland insisted on supporting conservative candidates, even when such support might cut against their own economic interests. Frank’s answer was that conservatives were duping these voters by raising the salience of social wedge issues like abortion and same-sex marriage.

In the years since Frank’s book became a touchstone in liberal circles, conservatives have consistently blasted Frank’s thesis as a condescending and elitist anthropologic dive in to the Heartland’s psychology. It exposed the “smug superiority on the left,” they said. Even today, they condemn Frank’s narrow vision of what’s good for the working class: “To Frank, the idea that voters might have interests beyond their economic status was unthinkable.”

Regardless of whether one accepted Frank’s theory, he was early detecting a certain angst in the Heartland. The possibly curious voting patterns were simply an indicator that something was awry.

We are now learning that Frank may have had his thumb near the pulse of a deeper crisis than we knew. In November, economists Anne Case and Angus Deaton published a jarring study finding that the mortality rate for middle-aged white Americans had singularly and sharply increased over the last decade and a half. The authors found that “poisonings” and suicides among this population had spiraled to previously unseen heights. People were medicating themselves, abusing opioids, and, increasingly, ending their lives.

Deaton speculated that these Americans had “lost the narrative of their lives — meaning something like a loss of hope, a loss of expectations of progress.” Traditional working class jobs like manufacturing had vanished. Access to economic opportunity with basic education was once the norm, but was now nonexistent. Despair in the heartland and among the working class was producing tangible and terrifying human devastation, the economists found.

At the same time, the Trump phenomenon was sweeping through this very population. Trump was trouncing in the counties with the highest middle-aged white mortality rates. He was winning county after county with the least college diplomas; the most people out of work; and the greatest loss of manufacturing employment. In short, Trump was cleaning up in Case-and-Deaton Country: the places without jobs, education, or hope—the places where people were quite literally dying from despair.

Establishment conservatives, of course, have been tearing their collective hair out over the rise of Trump. They’ve pleaded with voters to see through his con routine and reject his strongman show, marshaling all of the intellectual firepower in their arsenal against Trump’s march to the nomination. Suddenly, there was a test of the allegiance of the conservative elite to the white working-class they had long professed to defend.

So what does the conservative elite think of the communities they used to lionize as “real America” now that they insist on supporting a candidate they loathe? Enter the National Review’s Kevin Williamson:

“The truth about these dysfunctional, downscale communities is that they deserve to die. Economically, they are negative assets. Morally, they are indefensible. Forget all your cheap theatrical Bruce Springsteen crap. Forget your sanctimony about struggling Rust Belt factory towns and your conspiracy theories about the wily Orientals stealing our jobs. Forget your goddamned gypsum, and, if he has a problem with that, forget Ed Burke, too. The white American underclass is in thrall to a vicious, selfish culture whose main products are misery and used heroin needles. Donald Trump’s speeches make them feel good. So does OxyContin. What they need isn’t analgesics, literal or political. They need real opportunity, which means that they need real change, which means that they need U-Haul.”

When the Twittersphere collectively gasped in horror at Williamson’s denunciation, the National Review only doubled down, sneering at the “self-destructive moral failures” of “millions of Americans [that] aren’t doing their best. Indeed, they’re barely trying. [. . .] Simply put, Americans are killing themselves and destroying their families at an alarming rate. No one is making them do it. The economy isn’t putting a bottle in their hand. Immigrants aren’t making them cheat on their wives or snort OxyContin. Obama isn’t walking them into the lawyer’s office to force them to file a bogus disability claim.”

Paul Krugman rightly connects this sentiment to Mitt Romney’s contempt for the 47 percent of Americans who make too little to owe federal income taxes, and to Speaker Paul Ryan’s critique of our social safety net as a coddling “hammock that lulls able-bodied people to lives of dependency and complacency.” “Stripped down to its essence,” Krugman concludes, “the G.O.P. elite view is that working-class America faces a crisis, not of opportunity, but of values.”

Simply put, this is the go-to conservative diagnosis of widespread crisis among those caught in the lower rungs of the social ladder. When evaluating (predominantly black) urban poverty, Ryan once warned that “[w]e have got this tailspin of culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working or learning the value and the culture of work.” And when assessing what ails the unemployed, former Speaker John Boehner said the jobless would “rather just sit around” and coast off of public benefits.

Conservatives have been tsk-tsk’ing the morals of the urban poor and the jobless for years. Never mind that disability rolls have swelled in close correlation to the exodus of blue-collar jobs. Never mind that slashing unemployment benefits does nothing to aid the job search process. And never mind that the supposed cultural rot conservatives detect in poor African-American communities can overwhelmingly be traced to pervasive systemic disadvantage. When a community is in need, conservatives can almost always find a moral failing lurking close behind.

Yet this begs the fundamental question of whether a community’s moral anguish is the cause or the effect of its suffering. To Williamson and others, the white working class has “lost the narrative of their lives” because they picked up heroin needles, crushed OxyContin, and pulled one over on the Social Security office. End of story.

But under a more sympathetic—and, to my mind, more compelling—view of these communities, something has caused them to lose the narrative of their lives, and in response, they have stood numb as work disappeared, have resorted to disability checks just to make ends meet, and have increasingly succumbed to drug abuse or worse. The sky-high rate of poisonings, the futile search for meaningful work, and the alarming frequency of self-inflicted harm are indicators of a deeper existential crisis—a loss of self-value from far-reaching systemic upheaval. The dispiriting data uncovered by Case and Deaton are the symptoms, not the underlying disease.

What Case and Deaton want to discover—and what liberal policymakers want to fix—is that something: the root cause of this despair and these unmoored bearings. It’s undoubtedly too late to return to the ‘60s and on-shore a vast and job-intensive well-paying manufacturing sector. But if nothing else, we can craft a modern social insurance system to match the volatility and realities of 21st century capitalism. Indeed, if we want to reap the tremendous gains of such an economy, we have a moral obligation to cushion those whom it inevitably fails.

But if the determinative moral failing is the individual’s (or the community’s), then conservatives can rest easy while doing little to remedy the plight. And that’s the causation they’ve largely chosen: the cause of a community’s pathology is the community’s insistence on being pathologic. The fix is for the community to simply stop acting in pathologic ways.

It’s a diagnosis that confers agency and abhors dependency, it’s claimed. But how convenient that this theory of what ails the working class so neatly fits within the contours of the laissez-faire free-marketeering predisposition of conservatism. It’s a theory that lets conservatism wash its hands of the struggle of the dispossessed. Why alleviate hardship when you can moralize as it festers?

Conservatism has long claimed to defend the working class and the rural heartland from the snobbery of self-styled liberal elites. Now we know that these communities are suffering immensely in the twenty-first century. And the suffering has grown so acute that these communities have latched on in great numbers to a duplicitous and vulgar anti-politician who gives uninhibited voice to their rage and sense of past greatness lost.

Rather than defend these communities, some conservatives are turning their fire on them. “They deserve to die,” Williamson snorts. Which suggests that Frank was onto something all along. The white working class believed that conservatism had its back. But if there was ever any doubt, now it’s becoming clear: when times grow tough, too often the first instinct of conservatism is to cast judgment rather than to extend a helping hand.

The Week: “Divide and conquer” and the deserving poor

Over at The Week, I have a piece on Republican candidate for the North Carolina Senate seat Thom Tillis’s “divide and conquer” comments and the lineage of our thinking about who deserves public assistance:

Last week, as Tillis was wrapping up the Republican primary, footage was discovered of remarks he made in 2011 about wanting to “divide and conquer the people who are on assistance.” [. . .] Some have compared this video to Mitt Romney’s infamous “47 percent” blunder in 2012. But where Romney exploited fault lines between the supposed makers and takers, Tillis stoked a different social division: the deserving versus the non-deserving poor.

Check out the rest here.