When Republicans blindly railed and wailed against the Democratic health-care reform effort in 1993, they at least came up with a legislative alternative: the HEART Act, or Health Equity and Access Reform Today Act of 1993.
As most of us know, a good portion of the ACA, or Patient Protection and Affordable Care Act (and its companion Health Care and Education Reconciliation Act) of 2010, colloquially known as “Obamacare,” drew many of its key provisions — including the individual mandate — from the HEART Act.
Of course, neither the HEART Act nor the Clinton proposal made it through Congress, and we had to wait another 16 years for a unified Democratic government to take another crack at crafting actual policy that would at least attempt to accomplish three important policy goals:
- get the uninsured, insured;
- bring medical and insurance costs down by, inter alia, reducing aggregate uninsured medical risk; and
- protect consumers from the more egregious abuses perpetrated by the medical insurance industry.
We’re all familiar with the relentless campaign of cynicism and bad faith that the Republican party and its fans/enablers deployed against the ACA both before and after its passage and implementation, and we all know that as with every other Democratic policy that Republicans and their fans/enablers have blindly railed and wailed against since 1993 none of their dire predictions came true. There’s really no need to recap all of that here.
What should have been obvious even in 2009 to anyone with a pulse and more than three functioning synapses, and has been obvious to us for most of that time, but for some reason a lot of people seem to only now be coming to understand, is that the Republican Party has no health care policy and, at least since the HEART Act, never did. The GOP never had any principled, policy-based objections to the ACA, never mind that it was loaded with their own ideas; Republicans’ stated objections were purely ideological in nature, where not entirely cynical and dishonest, and of course, they never came up — and, importantly, were never challenged to come up — with a better (i.e., cheaper and/or more effective) policy.
One of the main reasons for that is that since the HEART Act, the Republicans have never been the least bit interested in accomplishing (let alone in crafting policy directed at accomplishing) any of the three policy goals enumerated above. They have no interest whatsoever in insuring the uninsured or protecting consumers, and have never even expressed any interest therein; to the extent they might be interested in bringing costs down, that’s only for people who can already afford health insurance. The Republican policy goal when it comes to health care is singular, simple, and straightforward: Keep the insurance, hospital, biotech, and pharmaceutical industries profitable.
Their secondary goal, perhaps, is to keep those who can’t afford health care from having access to the system that those who can afford it currently enjoy. I had a conversation recently with a Republican-leaning friend whose spouse was in the hospital at the time (this was just before COVID); this person was deeply concerned that expanding access to health care would diminish the quality of care that their family could get. In other words, Republicans think of health care as a luxury, something that should be reserved for those (like themselves) who can afford it, not “given” to those who can’t. Still, reserving the system for those who can afford the luxury thereof serves the primary goal of maintaining the profitability of the relevant industries, by inter alia suppressing demand and reducing write-offs for uncompensated care.
Laying all that aside for the moment, regardless of what one’s policy goals are there’s a difference between policy goals and policy. To put it as simply as one can, the former is what you want to accomplish, the latter is how you go about accomplishing it through legislation and administrative processes (rulemaking and enforcement), i.e., the things that government actually does. And that’s where the Republican party comes up short; they simply can’t translate their ideological goals and rhetoric into anything that would be workable in practice, anything that could be put on paper in the form of a statute or administrative regulation.
Steve Benen has a whole book out about how Republicans became a “post-policy” party, and I just recently wrote a diary discussing why Republicans don’t do ‘policy’ in the context of abortion, one of their ubiquitous pet ideological issues wherein even if one finds the ideology appealing (“sanctity of life” and what-not), the actual policy that could conceivably put that ideology into practice...
(1) that all pregnant women and girls must remain pregnant against their will, against medical advice, regardless of the risk, under penalty of law, until the pregnancy ends naturally; and (2) that public resources (including, but not limited to, police, prosecutors, courts and prisons) [must] be devoted and deployed to enforce the foregoing requirement and to investigate, as a criminal matter, every pregnancy that does not end in a live birth
...is utterly appalling.
The same, I think, applies to the health care issue; even if one finds their ideological slogans appealing (e.g., “market-based solutions,” “patient-centered health care,” &c.), the policy that could put their rhetoric into practice is downright appalling. I made a couple of attempts in 2012 to translate the GOP’s ideology on health care, viz., both stated (“free-market” health care, a luxury) and implied (keep the relevant industries profitable) policy goals, into actual legislative and administrative policy, and the results were … well, you decide:
- Repeal both the [ACA] and EMTALA (Emergency Medical Treatment and Active Labor Act of 1986), alleviating the requirement that ERs and EMS treat all patients regardless of insurance, payment and/or citizenship.
- Make it illegal for any 911 operator or hospital personnel to dispatch or administer any medical treatment or services of any kind, including emergency, to any person they have reason to believe is uninsured and cannot afford to pay in full.
- Limit the liability of 911 operators, EMTs, hospital staff, &c. for negative medical outcomes caused by delays and errors in ascertaining insurance/payment prior to treatment.
- Eliminate all liability for medical malpractice in cases involving uninsured patients and/or unpaid-for medical services.
- Provide civil and/or criminal penalties for calling 911 or showing up at an ER without insurance and without paying in full up front (i.e., for trying to free-ride off the system).
- Eliminate Medicare, Medicaid, Social Security Disability, and S-CHIP.
- Privatize the V.A.
- Reimburse insurers for any ACA-related expenditures they've incurred to date, including medical-loss ratio refunds and medical expenditures in excess of pre-ACA lifetime caps.
- Direct the states to eliminate all insurance regulations and medical-malpractice laws; reimburse insurers for any state regulatory expenses, including violation fines, and medical-malpractice judgments, incurred since the ACA was passed.
- Eliminate all federal funding assistance for 911, EMT and Medevac services.
- Make it a federal crime for any hospital or medical provider to provide any treatment of any kind to any uninsured person or any non-U.S. citizen, or anyone the provider has reason to believe is uninsured or is not a U.S. citizen, and eliminate civil liability of providers for any negative medical outcomes caused by delays or errors in ascertaining insurance and citizenship.
So far, I haven’t heard or read a better explication of what Republican policy on health care would actually look like if we took them at their word over the past decade as to what their ideological and policy goals for health care are.
Because Republicans are only genuinely interested in maximizing the profits of their Party’s owners and seeing to it that they are never held accountable for the harm they cause to the public, workers, consumers and the environment, the Party has long since given up on legislating and [small-a] administration, which they don’t need to do in order to keep their donors happy. The added benefit of having only unprincipled ideological objections to the other party’s policies and no actual policy of your own, is that you never have to keep your campaign promises; you can keep promising to end abortion and come up with a “market-based,” “patient-centered” health care “plan” from now until the end of time, and your voters will keep voting for you even though you never accomplish them.
At the end of the day, the reason why Grand Nagus Drumpf hasn’t come up with the “better” and “cheaper” health-care “plan” that he’s been promising for half a decade, and that his Party has been promising for a full decade, is as obvious as it is simple: they have no idea how to do it. Nor do they care to know how to do it, or really need to know how to do it.
Because Republicans don’t do ”policy.”