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Why the Republicans Can’t Win on Health Care

President Trump Speaks At The White House After The House Voted On Health Care BillPresident Trump Speaks At The White House After The House Voted On Health Care Bill
Ryan enjoys the moment. Alex Wong Getty Images

Good morning.

Here’s hoping you didn’t spend your weekend reading or watching coverage of the health bill passed by the Republican House last week. I did, and it was time wasted. Neither the journalists covering the bill nor the political partisans defending and attacking it did a very good job explaining to the American people exactly what this bill does.

That’s partly because the effects are complex and indeterminate. In simplest terms, the bill gives states and insurers more freedom to craft insurance plans as they please, reducing Washington mandates and subsidies. Inevitably, that will create winners and losers. But without knowing which states will request waivers, or how insurance companies will reshape and reprice their plans, it’s hard to know exactly who the winners and losers will be.

Here ‘s one thing, however, that’s already abundantly clear: Merits aside, this bill is a political loser for the Republicans. There are three simple political rules that explain why:

1) Anecdotes and stories are more powerful than data and analysis. Even if the bill’s defenders are right that it will create less expensive and more flexible insurance options for most people, stories of those who see their health insurance bills skyrocket because of preexisting conditions will grab the headlines and the public attention.

2) Real losses matter more than potential losses. Even if the House bill is trading off higher costs for some people with preexisting conditions in return for lower premiums for the majority, the former will feel the pain more clearly than the latter will feel the benefits.

3) Losers scream louder than winners. That’s a political reality that also will haunt the Trump team if it tries to tackle tax reform (as opposed to everyone-wins-for-now tax cuts.)

At the risk of being repetitive: this is why complicated social legislation needs to be passed with bipartisan support. Back in 1983, Alan Greenspan headed a bipartisan commission that raised the Social Security retirement age in order to balance the program’s finances. If Republicans had done that alone, they would have been slaughtered with political ads in the 1984 election. But because both parties joined hands and jumped together, it was accepted as a necessary, if painful, fix. That’s how political leadership should work.

Could the Senate still take a bipartisan approach to health care? It’s possible, as Democratic Senator Joe Manchin told Politico recently. But it requires Republicans to turn from “repealing” the Affordable Care Act to “fixing” it – a semantic distinction that’s now blocking compromise.