Before discussing the events of today in the Senate, I want to note a subsidiary issue, a matter of press coverage. But this is not a secondary issue in terms of importance. Let me also preface this by saying I’m going to focus on another journalist: CNN’s Dana Bash. I don’t know Dana. But I’ve relied on her reporting on CNN for years. So this isn’t meant as an attack on her. To me it is simply an illustration of a broader failure of coverage.
With that, here goes.
The following is the transcript of a brief exchange between Wolf Blitzer and Bash just after Mitch McConnell delivered some brief remarks outside the White House after the Senate GOP conference met with the President. We come in immediately after McConnell finishes speaking.
BLITZER: So there is the Senate Majority Leader, Mitch McConnell. There is a headline there. He really doesn’t want to work with the Democrats if the Republican legislation were to fail. He specifically said that none of the reforms the Republicans want as far as market reform, Medicaid reform would be acceptable to the Democrats. Dana Bash, significant statements from the Majority Leader if it were to fail, basically saying it’s the Republican version, whatever tinkering they do now, has to pass.
BASH: Absolutely. Look, he is speaking the truth in a lot of ways. Philosophically, the two parties are and have been for some time, very, very different on their sort of global approach to health care. I think that people, though, out there looking at this [are] saying, why can’t these parties work together on something that is such a huge part of the economy, that is something that is so vital to everybody’s lives, all of their constituents’ lives. [It’s] mind boggling. But you know what, it happened when the Democrats passed Obamacare. They will tell you from the Obama team that they tried very hard to get Republicans and they weren’t playing ball. But it’s happening now that Republicans are in charge, too.
There’s a lot here.
I should begin by saying that I think Bash is right for many voters. But the reality is that this is the case because the coverage of national health care policy is fundamentally distorted by the imperatives of false balance or forced balance coverage. The idea here is that the two parties are so set in their ideological corners that they can’t constructively come together and find points of compromise to address issues of great public concern. But this sentiment only makes sense if you think both parties are trying to accomplish something approaching the same thing, albeit perhaps with very different strategies. That is simply not true.
This is all of a piece with the drama surrounding the successive CBO scores, each of which have been remarkably similar. The three have shown 24 million, 23 million and most recently 22 million losing their health insurance coverage by 2026. To have the numbers so close you’ve got to be following a pretty consistent strategy. The Democrats’ goal with the ACA was to increase the number of Americans who had health insurance coverage. They did it with a mix of operating through private insurance companies (the exchanges/market places) and dramatically increasing the number of Americans eligible for Medicaid, which is essentially a national single payer plan for the poor.
The results have been far from perfect. But the number of people with insurance has risen dramatically since passage of the ACA in 2010. This is an undeniable statistical reality. The Republican plan has been to repeal the bill and take coverage away from the people who received it. That may sound like a partisan way of understanding the situation. But that’s only because we’ve absorbed the skewed coverage.
We talk a lot about how Republicans real focus is getting the ACA money for a big tax cut, which is unquestionably true. You can only get the tax cut if you get back the money that went toward getting people covered. But at a deeper level this is a philosophical dispute, a basic difference in goals. It’s a difference in desired outcomes, not an ideological dispute over the best way to achieve them.
Current Republican ideology, if not all Republicans, posits that it is simply not the responsibility or place of government, certainly not the federal government, to make sure everyone has health care coverage. You can agree or disagree with that premise. But it’s not hard to understand and it is not indefensible. Very few of us think the government should step in if someone doesn’t have enough money to buy a car. We don’t think there’s a right to a home or apartment where every child has their own bedroom. On most things we accept that things are not equal, even if we believe that extremes of inequality are bad for society and even immoral.
But many of us think that healthcare is fundamentally different. It’s not just another market product that we accept people can or can’t get or can or can’t get at certain levels of quality because of wealth, chance, exertion and all the other factors that go into wealth and income. This is both a moral and ideological premise.
One might more sympathetically say that Republicans believe that the market can more reliably and cheaply provide coverage in comparison with the government. But there’s little evidence this is the case with health care coverage – certainly not when it comes to the big picture issues of constructing insurance markets in which some people have dramatically less money and dramatically higher risk. In any case, Republican health care policies since the beginning of this century have shown very little interest in using market mechanisms to expand care. After all, Obamacare is a more progressive and redistributionist implementation of an idea that emerged from Republican think-tanks looking for policy alternatives to a national health care social insurance plan like what we now call “single payer.”
When you try three times to ‘repeal and replace’ and each time you come up with something that takes away coverage from almost everyone who got it under Obamacare, that’s not an accident or a goof. That is what you’re trying to do. ‘Repeal and replace’ was a slogan that made up for simple ‘repeal’ not being acceptable to a lot of people. But in reality, it’s still repeal. Claw back the taxes, claw back the coverage.
Pretending that both parties just have very different approaches to solving a commonly agreed upon problem is really just a lie. It’s not true. One side is looking for ways to increase the number of people who have real health insurance and thus reasonable access to health care and the other is trying to get the government out of the health care provision business with the inevitable result that the opposite will be the case.
If you’re not clear on this fundamentally point, the whole thing does get really confusing. How can it be that both sides flatly refuse to work together at all? As Bash puts it, “Why can’t these parties work together on something that is such a huge part of the economy, that is something that is so vital to everybody’s lives, all of their constituents’ lives, [it’s] mind boggling.”
If you had an old building and one group wanted to refurbish and preserve it and the other wanted to tear it down, it wouldn’t surprise you that the two groups couldn’t work together on a solution. It’s an either/or. You’re trying to do two fundamentally opposite things, diametrically opposed. There’s no basis for cooperation or compromise because the fundamental goal is different. This entire health care debate has essentially been the same. Only the coverage has rarely captured that. That’s a big failure. It also explains why people get confused and even fed up.
