Hating government doesn't solve problems
In its current iteration, the Republican Party truly seems to believe that the solution to every problem involves throwing more money at rich people. This explains the health care fiasco in the Senate, and it's why President Trump and Congress have yet to address a single major problem the country faces.
Everything is secondary to the GOP's two opening legislative priorities: gutting Obamacare, and passing a tax cut.
The president has talked a lot about infrastructure but he has offered no plan and Congress shows few signs of coming up with one anytime soon. Trump loves to say he wants to help those battered by economic change. But his actions in this sphere have been entirely symbolic. There are no comprehensive proposals for, say, using training, community colleges and the apprenticeships he was touting recently to open up new opportunities.
There have been steps to eliminate regulations protecting workers, consumers and the environment, rationalized as job-creation measures. This is just trickle-down economics in another form: Whatever fulfills the desires of the most privileged sectors in our society is declared to be good for everyone else. But God forbid that government do anything to help the non-rich directly.
It's not true that every problem has a government solution. But it is true that certain problems can only be addressed by government. One of these is helping all Americans afford a decent health insurance policy. It's this simple: To cover everyone, government has to spend a lot of money.
Why? Because unless you get your coverage from an employer or have an income in excess of (conservatively) $75,000 a year, the expense of insurance is crushing to your household budget.
"In 2017," the Milliman Medical Index reported last month, "the cost of health care for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $26,944."
This figure includes out-of-pocket costs, but insurance itself is expensive enough. Earlier this month, the National Conference of State Legislatures pointed out that "annual premiums reached $18,142 in 2016 for an average family."
Now, consider this: Someone working full time at $10 an hour earns $20,800 a year before taxes; at $15 an hour, $31,200; at $20 an hour, $41,600. The median household income in 2015, according to the most recent Census Bureau figures, was $56,516.
Is it any wonder that it's so hard for so many to buy health insurance?
Putting health coverage within reach of everyone thus requires either large-scale subsidies for private plans or direct government spending, as in Medicaid and Medicare. The Senate bill would toss 22 million people off health insurance for one basic reason: It cuts federal spending on Medicaid and insurance subsidies by more than $1 trillion and then plows most of that into tax reductions.
There is no getting around it. You can't do what the GOP wants to do without hurting a lot of people. This is why pious pleas for the parties to work together are, for now, empty. Of course it would be far better for Democrats and Republicans to agree on ways to improve our health system, and it's nice to hear a few GOP senators saying so.
To get to that point, Republicans would have to abandon the fiction that they can slash spending on subsidies and Medicaid without anyone paying a price. They also need to accept that it will take government action to rein in health care inflation — for example, through harder bargaining with drug companies.
Republicans did not always fixate on taxes and smaller government above all else. Dwight Eisenhower was bold in building the interstate highway system and creating federal student loans. Richard Nixon — yes, Nixon — was similarly forward-looking in creating the Environmental Protection Agency and the Occupational Safety and Health Administration. Oh, and Nixon actually proposed universal health coverage.
This health care imbroglio should be the Republicans' moment of truth. If tax cuts and scaling back government are all that matters to them, they should stop pretending they even care about solving problems that require substantial government outlays. They can out themselves as economic libertarians, which would at least be intellectually coherent.
Or they can drop the tax obsession and admit that delivering what most Americans want from government will make it large and complicated. A start would be acknowledging, along with nearly every other conservative party in the world, that if you hope to guarantee health care for all, only some form of Big Government can get you there.
— E.J. Dionne's email address is firstname.lastname@example.org. Twitter: @EJDionne.