Slate - "The GOP Dream is Impossible"
Why Do Republicans Hate the Republican Health Care Plan?
Because the GOP has policy goals that can’t be achieved.
By Reihan Salam
http://www.slate.com/articles/news_and_politics/politics/2017/03/why_republicans_hate_the_republican_health_care_plan.html
As expected, Paul Ryan has released a sweeping proposal—the American Health Care Act—to remake the U.S. health care system. Also as expected, lots of people hate it. What’s somewhat more surprising is that so many Republicans seem to hate it.
Why won’t the GOP line up behind the party’s Obamacare replacement? The basic story is that ideological purists don’t like the fact that the House proposal creates a new system of refundable tax credits, which they see as tantamount to socialism. Meanwhile, Republican pragmatists from states that expanded Medicaid under Obamacare are afraid that Ryan’s overhaul will leave many of their low-income constituents high and dry. The disagreement between these two positions is ultimately a matter of political calculation. The purists, most of whom are from solidly Republican constituencies, see getting rid of Obamacare root and branch as the mission their voters sent them to Congress to accomplish, and they want to do it even if it means millions of insurance policies get canceled and swing voters go nuts. The pragmatists, who tend to be drawn from more competitive districts and states, don’t want to push things quite so far.
Normally you’d expect members of the same party to hammer out an agreement. The purists would recognize that the pragmatists need to win their races if the GOP is going to retain control of the House and Senate, and so they’d find a way to work together. That’s exactly the kind of deal Ryan is trying to forge. The problem is that the intra-Republican compromise he’s devised doesn’t make anyone happy. That’s because, to put it bluntly, Republicans have policy goals that simply can’t be achieved.
David A. Hopkins, a political scientist at Boston College, offers an elegant explanation. While the Democratic Party functions as a coalition of discrete social groups, each of which wants government to help address various problems, the GOP functions more as the agent of the conservative ideological movement. This is not to say that Democrats are never ideological. Far from it. It’s just that ideological liberals who, say, would have greatly preferred Medicare-for-all over the kludgy, compromised mess that is the Affordable Care Act weren’t willing to sink Obamacare because it was an affront to their deeply held beliefs. Instead, they sucked it up and backed the president’s health care plan, thinking it would deliver real-world benefits to their constituents. There were plenty of ideological liberals who hated having to cut deals with insurers and pharmaceutical companies and the hospital lobby yet were willing to do just that to achieve their goal of expanding coverage. Republicans, in contrast, have devoted almost no effort to placating industry stakeholders in the health sector—a sector that accounts for roughly 18 percent of GDP, by the way—nor are they delivering much in the way of tangible benefits to rank-and-file Republican voters.
snip = long and worth reading.
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