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Is the Republican health plan designed to fail?

There’s a theory going around Washington that Republicans don’t want their health bill to pass.

U.S. Congress Holds Memorial Ceremony For Former Rep. Bob Michel Photo by Justin Sullivan/Getty Images

There is a line worth noting in David Brooks’s column today: “The Republican plan will fuel cynicism. It’s being pushed through in an elitist, anti-democratic, middle of the night rush. It seems purposely designed to fail.

Quietly, the idea that the House bill is designed to fail is percolating around Washington. I’ve heard it from a half-dozen people now. The law’s construction is shoddy. The outreach has been nonexistent. The hypocritical, hyper-accelerated process is baffling. Nothing about it makes sense.

But if you flip the intention — if you assume Republican leaders want to see a repeal-and-replace bill die in the Senate so they can say they tried and move on to tax reform — all of a sudden, it makes much more sense. It explains why more time wasn’t spent getting the bill right. It explains why they’re going so fast. It explains why they don’t care what the Congressional Budget Office says. It explains why they aren’t doing the outreach that would normally buffer them from this backlash.

Why would they want their own bill to fail? Well, consider the predicament they’re in. Republicans have spent seven years promising to repeal and replace Obamacare. They won election after election atop that vow. But now that they have the power to make good, they’ve run into three problems.

First, Obamacare has become popular. Second, they don’t have an alternative plan that would make good on their promise to provide more people with more generous health care at lower cost. Third, implementing a repeal-and-replace plan — with all the complexity and disruption that entails — will drown the rest of the GOP’s agenda, and perhaps its congressional majority.

Arguably, the best outcome for Republicans is to try to replace Obamacare and fail. And if you believe that’s what they’re doing, much else falls into place.

Take the GOP effort to discredit the Congressional Budget Office’s analysis rather than working with the agency to build a better bill. For that play to work, they need credible, independent validators of their ideas. In 2009, when Democrats wanted to argue that the CBO was underestimating the savings from delivery-system reforms, they pointed to work by Harvard’s David Cutler, among others. The key to their argument was that top health experts disagreed with the CBO, and they made lengthy, plausible arguments explaining why. That’s what this looks like when you’re really trying.

The House GOP isn’t really trying. The conservative intellectual apparatus is overwhelmingly against Ryancare — when you’ve lost Cato and Heritage and AEI and Yuval Levin and Avik Roy and Philip Klein, then discrediting CBO doesn’t come off as CBO is wrong, and here’s a persuasive argument for why; it comes off as we’re wrong, and we’re trying to make sure as few people as possible know it. It’s a flashing signal of weakness.

Nor is it just the conservative intellectual apparatus that is panning Ryancare. It’s also the health care industry. So far, the American Medical Association, the American Hospital Association, the American Nurses Association, AARP, and a host of others have come out against the bill. This is important, because every House member has doctors and nurses and hospitals in their district. It’s a decision that scares legislators rather than comforts them.

Paul Ryan isn’t an amateur. He is, arguably, the most skilled policy entrepreneur of his generation. He is known for winning support from political actors and policy validators who normally reject his brand of conservatism. The backing he’s built for past proposals comes from painstaking work talking to allies, working on plans with them, preparing them for what he’ll release, hearing out their concerns, constructing processes where they feel heard, and so on. He’s good at this kind of thing. But he didn’t put in the work here. And there are consequences to that.

Imagine you’re a backbench Republican House member. You’re a conservative. You didn’t see this bill until Monday. All the think tanks you normally rely on — all the think tanks you normally agree with! — hate it. The hospitals hate it. The doctors hate it. The major conservative activist groups hate it. Your leadership appears afraid of CBO’s analysis — even though they appointed the director of the CBO! Wouldn’t this look a bit weird to you? You want to be a good soldier, of course. Paul Ryan says this is your only chance to repeal and replace Obamacare, and Obamacare is terrible. But you’ve got to be a bit antsy. How much would it take to shake you?

That’s the context in which to read this piece Yuval Levin, a conservative intellectual who is among the party’s most influential voices on policy. “I suspect that in a week's time its authors will look back fondly on that difficult start as the glorious interlude before the Congressional Budget Office had scored the proposal,” he writes. With a beginning this rocky, it may not take much to scare Republican legislators who are already pretty anxious.

So do I think the GOP plan is built to fail? I don’t. Washington is always more Veep than House of Cards. But I do think Republicans went into this process believing that failure was likely, and so tried to hedge against the consequences by putting hard boundaries around the process. They decided that if they were going to fail at this, they were going to fail fast, over the course of a month or two, not waste a year on the project.

But that decision — and the push for secrecy and mania for speed that have accompanied it — has left Republicans in an indefensible position, and with a very weak bill. In some ways, the scariest outcome for Republicans now isn’t that they fail, as expected, but that they unexpectedly succeed, and have to implement a bill no one really believes will work.