The GOP's "Do Nothing" Plan for Health Care

During the presidential campaign, Republicans enjoyed poking fun at Obama's "Yes, We Can," campaign slogan. Most often they simply restated it as "No, You Can't." However, the GOP majority in the House is setting out to exemplify its own slogan: "No, We Can't."

The "We" in this case is the same "We" Obama spoke of with his slogan — the collective "We," encompassing all Americans. "No, We Can't," however reflects the GOP's emphatic belief that when it comes to the challenges we face — from health care to climate change and then some — there's just nothing we can, or should, do.

Again, I mean the collective "we" [1] that Thomas Friedman spoke of when he wrote that there's no "we" in American politics [2].

Our leaders, even the president, can no longer utter the word "we" with a straight face. There is no more "we" in American politics at a time when "we" have these huge problems — the deficit, the recession, health care, climate change and wars in Iraq and Afghanistan — that "we" can only manage, let alone fix, if there is a collective "we" at work.

It's the "we" that Martin Luther King Jr. referenced in his Letter from the Birmingham [3] Jail, when he wrote: "We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly."

It is the "we" that President Obama mentioned in his, when he remarked on the late Sen. Ted Kennedy's passion for health care reform during speech to Congress [4].

On issues like these, Ted Kennedy’s passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick. And he was able to imagine what it must be like for those without insurance, what it would be like to have to say to a wife or a child or an aging parent, there is something that could make you better, but I just can’t afford it.

That large-heartedness—that concern and regard for the plight of others—is not a partisan feeling. It’s not a Republican or a Democratic feeling. It, too, is part of the American character—our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

It's a "we" that the GOP no longer believes in [5], if it ever did. Their position that we are not "caught in an inescapable network of mutuality," that "whatever affects one directly" does not "affect all directly," and that we are not "all in this together," is perhaps best reflected in a sign carried by a Tea Party protestor [6] at a demonstration against health care reform.

Where president Obama lauded Kennedy's ability, despite his privileged position, to "imagine what it was it must be like for those without insurance, what it would be like to have to say to a wife or a child or aging parent, there is something that could make you better but I just can't afford it," the "not-my-problem" ethos of conservatives now working to repeal health care reform before its full benefits take effect is reflected in the photo above.

It's also reflected in Republicans' attempt to repeal health care reform without having anything to offer in its place, as the GOP has no real alternative plan on health care [7].

With the House preparing to vote this week on whether to repeal the health-care law, the chamber's new Republican majority is confronting a far more delicate task: forging its own path to expand medical coverage and curb costs.

The House's GOP leaders have made clear that they regard the repeal vote, scheduled to begin Tuesday, as the prelude to a two-prong strategy that is likely to last throughout the year, or longer.

...On the cusp of undertaking this work, the GOP has a cupboard of health-care ideas, most going back a decade or more. They include tax credits to help Americans afford insurance, limiting awards in medical malpractice lawsuits and unfettering consumers from rules that require them to buy state-regulated insurance policies. In broad strokes, the approach favors the health-care marketplace over government programs and rules.

House Republicans have termed their strategy "repeal and replace." But according to GOP House leaders, senior aides and conservative health policy specialists, Republicans have not distilled their ideas into a coherent plan.

The Washington Post article above also quotes GOP Congressman Fred Upton (OH) as saying, "Replacing 'Obamacare' is not something we can accomplish overnight... We want to get it right, and on complex issues like these with huge consequences for the economy and jobs and spending, that means it may take time. But mark my words, we will get this done." In the meantime, as unlikely as it seems, successfully repealing health care reform would mean returning to the status quo, with devastating impact [8] and loss of new protections [9] for millions of Americans.

If health care reform were successfully repealed, with no alternative plan to take its place:

• Thirty million Americans who would have coverage thanks to health care reform would continue to do without it.
• Millions more who are now sure they'll be able to keep or replace coverage if they lose their jobs will no longer have that security.
• Insurance companies will still be able to deny coverage based on pre-existing conditions. (According to a new study, that means about half the country will be uninsurable [10]. We are indeed a nation of burned down houses [11].)
• Insurance companies will still be able to deny coverage to children with pre-existing conditions.
• Insurance companies will still be able to set annual and/or lifetime caps on health care coverage.
• Insurance companies will still be able to rescind policies after a person becomes sick.
• Young people would no longer be allowed to remain on their parents' insurance until age 26.
• Insurance companies would not be required to cover preventative care in new policies, without cost sharing.
• Insurance companies would not be required to spend at least 80 percent of premium income on medical care and quality improvements, instead of administrative costs or simply pocketing the profits.
• Insurance companies will still be able to deny coverage to rape victims and victims of domestic violence.
• Insurance companies will still be able to classify pregnancies and C-sections as "pre-existing conditions," and thus use them as reasons to deny coverage.
• Americans who don't have coverage through their employers will not have the option of purchasing coverage through health insurance exchanges.
• The Medicare Part D "donut hole" will remain open.
• The cost of employer sponsored coverage will go up. By 2019 employers and workers may have to cough up $3,000 or more per year in per-employee health care costs.
• Consumers who don't receive coverage from employers will see their rates go up as much as 20% for the same coverage by 2019.
• Four million small businesses will lose eligibility for health insurance tax credits, forcing small business owners to pay $40 billion in additional taxes each year.
• Repeal would add to the deficit and cost the economy about 2 million to 4.5 million jobs by the end of the decade.

Instead, the GOP opts for what Mori Dinauer aptly dubs "principled helplessness." [12]

It is instructive to think about conservatism as a form of principled helplessness whereby we cannot countenance collective solutions to any public-policy problem, whether it's regulation of industry or basic sanitation services [13]. I think the principle at stake here is that we mustn't interfere with the natural order of things, which should be sussed out through the mechanizations of the market, but it doesn't take much to realize that "free markets" are actually the product of complicated relationships with government.

The bottom line is that some problems cannot be solved because principle holds that they must not be solved, and ideology declares that they should not be solved — at least not by the collective "we," in the form of government [14].

If conservatives can successfully halt, hinder or "repeal" health care reform, they will cite it as proof that "government can't do anything," and their belief that "government shouldn't do anything" will exempt them from offering solutions or "doing something" — like governing. Government will stand by and "do nothing" as more Americans caught in the economic crisis slide further into unemployment, poverty, deprivation and desperation. Governing will be a lot like standing by and watching a train wreck, from a safe distance. Conservatives, who believe that government shouldn't help, will make sure it doesn't help, and cite such as evidence that government can't help.

It's possible that many more Americans, under those conditions, will believe it. Government will be "the government" — serving the powerful, and remaining removed from and unmoved by the plight of many Americans. For those Americans, the possibility of government as "our government" — "of the people, by the people, for the people" — whose purpose is "to protect them and to promote their common welfare," [15] to do "some things we can't do on our own" and "some things we do better together," [16] could face. No entity capable of addressing the size and scope of the crises Americans fade, and driven by any interests other than private profit, will likely rise to fill the void.

The GOP's new "civility" and same old lies on health care reform [17] disguise a "do nothing" philosophy of government that abandons Americans most in in need in the midst of a crisis.

There are problems of such great size and challenges of such broad scope that they are unlikely to be solved by individual efforts, or small-scale efforts at the state and local level. Americans understand this. That's why a majority opposes repealing health care reform [18], and wish it went further [19]. But the GOP's objection to health care reform (and practically all reforms) is driven by a minarchism [20], favored by Tea Party libertarians [21].

Minarchism (sometimes called minimal statism, small government, or limited-government libertarianism) is a libertarian political ideology which maintains that the state's only legitimate function is the protection of individuals from aggression, theft, breach of contract, and fraud.

That not only runs counter to what the majority of Americans want but, as Christopher Beam explained in New York Magazine last month [22], it just won't work.

Libertarianism is a long, clunky word for a simple, elegant idea: that government should do as little as possible. In Libertarianism: A Primer, Cato Institute executive vice president David Boaz defines it as "the view that each person has the right to live his life in any way he chooses so long as he respects the equal rights of others." Like any political philosophy, libertarianism contains a thousand substrains, ranging from anarchists who want to destroy the state to picket-fence conservatives who just want to put power in local hands. The traditional libertarian line is that government should be responsible for a standing army, local security, and a courts system, and that's it — a system called minarchy...

Libertarian minarchy is an elegant idea in the abstract. But the moment you get specific, the foundation starts to crumble. Say we started from scratch and created a society in which government covered only the bare essentials of an army, police, and a courts system. I'm a farmer, and I want to sell my crops. In Libertopia, I can sell them in exchange for money. Where does the money come from? Easy, a private bank. Who prints the money? Well, for that we'd need a central bank-otherwise you'd have a thousand banks with a thousand different types of currency. (Some libertarians advocate this.) Okay, fine, we'll create a central bank. But there's another problem: Some people don't have jobs. So we create charities to feed and clothe them. What if there isn't enough charity money to help them? Well, we don't want them to start stealing, so we'd better create a welfare system to cover their basic necessities. We'd need education, of course, so a few entrepreneurs would start private schools. Some would be excellent. Others would be mediocre. The poorest students would receive vouchers that allowed them to attend school. Where would those vouchers come from? Charity. Again, what if that doesn't suffice? Perhaps the government would have to set up a school or two after all.

And so on. There are reasons our current society evolved out of a libertarian document like the Constitution. The Federal Reserve was created after the panic of 1907 to help the government reduce economic uncertainty. The Civil Rights Act was necessary because "states' rights" had become a cover for unconstitutional practices. The welfare system evolved because private charity didn't suffice. Challenges to the libertopian vision yield two responses: One is that an economy free from regulation will grow so quickly that it will lift everyone out of poverty. The second is that if somehow a poor person is still poor, charity will take care of them. If there is not enough charity, their families will take care of them. If they have no families to take care of them-well, we'll cross that bridge when we get there.

Of course, we'll never get there. And that's the point. Libertarians can espouse minarchy all they want, since they'll never have to prove it works.

(I would only add that, under "Libertopia" as Beam describes it, if that bridge is on fire when come to it, we won't put out the fire — on principle [23].)

The problem Republicans, having chosen to kick off their latest shot at governing with a cynically "symbolic" attempt to "repeal" health care reform, don't have the luxury of not having ideas that work, and not having to prove that their ideas work. On issues from health care reform to jobs and the economy, Americans just want something to work. And that means that government — the collective "we," that does those things we need done, that we can't do by ourselves, and that we do better together — has to do something.

Doing nothing just guarantees more misery for Americans [24] caught in the grip of the economic crisis, at a time when Americans want solutions. If Republicans can't or won't offer solutions, and stick to declaring that "nothing can be done" about the problems and challenge we face, in two years they may find that Americans want nothing more to do with them.