Why Republicans can’t do health care

Those internal tensions that have given us the botch that is the House G.O.P.’s Obamacare alternative. It’s a piece of legislation caught betwixt and between: It includes enough in the way of tax credits and regulation to be labeled “Obamacare lite” by the party’s would-be ideological enforcers, but it also promises to throw many people off the insurance rolls — many Trump voters included — for the sake of uncertain policy goals. Its outline bears some resemblance to what the smartest conservative health policy thinkers favor, but it doesn’t want to spend the money (whether on risk pools or pre-funded health savings accounts or income-linked subsidies) that would make that approach politically viable. And its desire to spend less while keeping Obamacare’s most popular regulations (the ban on discrimination based on pre-existing conditions, above all) promises to make the risk of an insurance death spiral that much worse.

So it’s a bill that nobody on the right much likes: Not libertarians and not reformocons, not right-wing donors and not mushy moderates, not the Tea Party senators who promised full repeal and not the swing-state senators who well know that their own voters want the coverage expansion to endure. As for Americans who aren’t ideologically committed, forget about it: Passing the bill would be an invitation to a political beheading.

But in fairness to its designers, there was no bill that could have united all of the right’s disparate factions, because on health care policy, as on a range of issues, the Republican Party as an organism does not know what it believes in anymore.

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