Sibylla Bostoniensis

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It has come to my attention that some of the Blue Nation is unclear on what is currently playing out on the Right in response to Ryancare. This is terrible: you're missing out on some top-shelf schadenfreude.

A crucial confusion is, apparently, not understanding that there are several different factions over on the Right right now. If you attempt to understand what is happening over there by generalizing from all the things everyone over there does, things look very self-contradictory. I mean, even more self-contradictory than they actually are.

Before explicating the factions and their agendas, I need to take a moment to recount how it has been long much observed that messing with Obamacare wouldn't work or wouldn't be possible, because of the Three Legged Stool principle. The Three Legged Stool of Obamacare was how the whole scheme rested on three parts: the individual mandate, the pre-existing conditions exclusion (and other rules that required insurers to offer insurance to everybody), and the federal government subsidies. If any one of those legs was removed, it was widely noted, Obamacare wouldn't stand. It would fall down.

What I don't think many in the Blue Nation grasped – that the Red Nation is slowly, to their horror, coming to discover – was that Obamacare is less like a house of cards, that might decorously collapse into a heap of paper, than like a skyscraper, that can only come down down catastrophically on top of whomever undermined it.

Obamacare is built like a bomb rigged to blow if tampered with. Rigged by someone much, much, much cleverer than any of the people currently trying to figure out how to defuse it.

So, quite simply, some of what you're observing on the Right is a diversity of responses to realizing that actually doing what one's been promising to do will likely be fatal to one's political career – but that not doing it is also likely to be fatal to one's political career, in measure with how vociferously one has promised one's constituents one would do this thing. Fewer and fewer Republicans by the day actually want to be the one to bell the cat.

Fully appreciating the delicious fix the Red Nation has got itself into right now is perhaps best attained by conceptualizing them as having three factions.

First, we have the rabid, ideological Tea Partiers, "small-government" libertarians, and fellow travelers who are demanding Repeal Obamacare Now. These are the people earnestly howling how Ryancare is Obamacare 2.0. (I think there are also people, especially in the Congress, howling about Ryancare is Obamacare 2.0 unearnestly, because of reasons more on which below.) They are furious that Trump promised to repeal Obamacare from the get-go, and has not. They are furious that the Republican majority of the legislature hasn't done so yet, either, and instead they have been given Ryancare which is so very not a full and total repeal of the ACA.

These people's response to "14 million Americans will lose insurance" is "GOOD! GET A JOB YOU BUMS!" and "Well it's a good start – what about the rest of the moochers?" They see Obamacare as a burdensome government entitlement that goes to other people than them that they pay for, and a requirement that they spend money on something they feel they shouldn't have to. They want that individual mandate gone and they want those government subsidies gone, especially the Medicaid Expansion, and... they actually don't care if the pre-existing conditions exclusion also goes, or possibly are actually antagonistic to it.

Let's call these people the Repealists.

Trump promised to repeal Obamacare – but also to replace it with something better. Which brings us to the next faction: the Trumpists who actually believed Trump when he promised that, and actually believe the Great Cheeto is going to pull a more generous, less expensive universal insurance system out of his ass. They feel entitled to great insurance for everybody – better than what they got out of Obamacare. Whereas the Repealists feel entitled not to have to pay for things like health insurance they don't feel they need, these folks both feel entitled not to have to pay for insurance for themselves or others if they don't want to, but also to be able to get really sweet deals on insurance.

Whereas the Repealists think the problem with Obamacare is being forced to spend money they don't want to spend (whether taxes or premiums), the second folks think the problem with Obamacare is that it prevents them from getting a better deal on insurance, which they're sure exists, somewhere. They are absolutely wedded to the pre-existing conditions exclusion which they feel is a basic right. They intensely dislike the individual mandate, and are indignant about it on principle – the principle of "You don't get to make me do nothin" – but actually are far more interested in how they're going to get health insurance; though they might not admit it, they feel that if they had a reasonable, affordable deal on great health insurance, they wouldn't have to be "forced" to buy it, and wouldn't much mind any such mandate law, except in principle.

They are convinced they are willing to pay their "fair share" for insurance, utterly out of touch with how inadequate the amount they feel is "fair" is to cover the actual cost of insuring them. They are convinced that the only reason that insurance is so expensive is that somebody, somewhere is ripping them off: the insurance companies, doctors, hospitals, Medicaid fraudsters, the shiftless poor, fake disabled people, etc. Consequently, they think the subsidies are unnecessary and can be done away with to reduce their taxes; they bought into the line sold them about Medicaid Expansion going to insure lazy non-contributing people. They are, just now, coming to realize that they and people they care about have been the beneficiaries of the subsidies and Medicaid Expansion, and that doing away with these things is maybe not what they want.

Let's call these people the Replacists.

The Repealists have been playing the Replacists for years. The Replacists want more-than-Obamacare, while the Repealists want less-than-Obamacare – like, absolutely-no-Obamacare. But the Repealists have been telling the Replacists the way for them to get what they want (more-than-Obamacare) is to help the Repealists repeal Obamacare.

Repealists: "Obamacare is why you have to pay so much for insurance! Help us repeal it!"

Replacists: "But, you'll replace it with something, better right?"

Repealists: "Uh.....suuuuuure we will!"

Replacists: "Okey-doke!"

One of the things that has been going on has been that – glorious to behold – the Replacists are finally in a position to demand the Repealists make good. The Replacists are like, "AT LAST! We have voted you in to Washington so you can give us the insurance you said Obamacare was keeping us from getting. So... where is it?"

The Replacists are reading the ACHA – or hearing through the media about the CBO report – and going, "...WAIT. WHAT THE HELL IS THIS?"

The third faction is harder to see. Call them the Parochialists. The Parochialists all know (believe) that campaign promises are lies, and that on the Right ideological posturing is just that – posturing. Things you say – things you have to say – to get elected on Republican tickets. Parochialists know (believe) that Republicans have to pay abundant lip-service to the idea of cutting government costs, but feel at the same time it's the job of representatives to bring home the bacon. Whether the Parochialist is Joe Sixpack wanting to know what his Congressman is going to do to Bring Back (never expressly said: to his state) The Jobs or a Congressman himself securing federal funding for a Bridge to Nowhere, the Parochialist knows that a representative's job is to see to the interests of his constituency – as his constituency understands them.

The Parochialists overlap heavily with the Replacists: like the Replacists, they would like to see the individual mandate go, and the pre-existing conditions exclusion stay. But unlike the Replacists, those aren't their highest priorities. No; unlike the Replacists, they know perfectly well what makes insurance affordable: the subsidies and the Medicaid Expansion. They know perfectly well that rolling back the Medicaid Expansion in their state means large numbers of voters losing their health insurance. They know that without the subsidies, they – or huge numbers of voting people in their state – lose insurance.

I want to make this explicit: there are people in the Red Nation who understand the math. They do understand what repealing the Medicaid Expansion and those subsidies would mean for the availability and price of insurance, and do not want to see that happen. Well, not in their state. They can't possibly say so, because there's absolutely no place in Red Nation rhetoric or ideology to support it. From their nominal political position, government entitlement programs (to individuals) are evil, government waste. They're pork. But the Parochialists feel entitled to pork – they always have. They have always understood a certain amount of discreet pork to be one of the perks of their DADT political ideological system. Parochialist representatives know that their job is to deliver that pork.

The Parochialists may be hard to see, but there's one place they're obvious. As Repealist pundits are pointing out, plenty of Republicans in Congress voted for an actual straight-up repeal of the ACA back when Obama was around to reliably veto it. Here's the National Review waxing wroth:

Repealing Obamacare is easy. Republicans already did it.

Every GOP senator except Illinois’s Mark Kirk voted for H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015. This full-repeal bill passed the Senate 52–47 that December. The House approved the measure the next month, 240–­181, with 239 Republican yeas and only three GOP nays.

Obama rejected this measure, alas, and then Congress failed to override his veto. “As Republicans, we decried the fact that Obama would veto it,” Representative Mark Sanford (R., S.C.) told journalists Tuesday. “Why would we now water down this same bill and send a new and weaker bill to President Trump?” Representative Jim Jordan (R., Ohio) is equally mystified:

We put on President Obama’s desk a bill that repealed Obamacare, got rid of every single tax, got rid of the mandates, and now the first thing Republicans are bringing forward is a piece of legislation that we’re going to put on a Republican president’s desk that says we repeal it but keeps Medicaid expansion and actually expands it, that keeps some of the tax increases. That is not what we promised the American people we were going to do.

Poor Representative Jordan is mystified – if it's not a rhetorical pose, which seems more likely – because these representatives aren't actually in favor of Repeal for real. These Parochialists representatives – and there are apparently quite a number – are happy to vote for repeal just so long as they're confident the bill won't pass. That way they get credit for being – dare I say it – politically correct in their stance towards Obamacare, but don't have to suffer the consequences of actually repealing their constituents' access to health care.

Thus we have the delightful pickle of Republican representatives from states that embraced the Medicaid Expansion. That would be some of them there pork. These largely Parochialist Republicans know that if they fuck up the Medicaid Expansion for their state, or cause premiums to death spiral, or bring back the specter of medical bankruptcies, they will have betrayed their electorate, which will be howling for their heads on pikes come the midterms.

The Repealists are ideologues and venal tools of the wealthy, blinded to political consequences by either their ideology or their greed. The Replacists have largely been fools, unable to keep track of which side their bread is buttered on. But the Parochialists are pragmatists and political survivors and they see exactly where this is going: dead photogenic children. Repealing Obamacare and "replacing" it with whatever garbage Repealist sleazeballs cook up to con Replacist marks is a fast track to cute poor kids dying tragically from untreated medical conditions on hospital steps. The optics, as they say, will not be good. Indeed, they will be dire for whomever it gets pinned on. The Parochialists know this and are quite sure they don't want it to be them.

And so: Ryancare.

Ryancare is – as I hope is obvious – Replacist. It is a deeply terrible replacement for Obamacare, a woefully inadequate joke of a replacement, but by gum it is a replacement not a repeal. Ryancare indulges Replacist demands, not Repealist ones, hence Repealist fury:

• It pays lip-service to abolishing the individual mandate, while introducing as a replacement a cost penalty for non-continuous coverage to (weakly, half-heartedly) impel people to have insurance. This is obviously necessary to providing an allegedly superior form of coverage to Obamacare – which the Replacists demand – but infuriates the Repealists who fundamentally do not want to be pressured or coerced into buying insurance for themselves.

• Ryancare keeps the pre-existing conditions exclusion, about which the Replacists are passionate but which the Repealists don't much care about – and which the Parochialists understand the cost of.

• Ryancare slashes and reorganizes the subsidies to claim to Replacists that the new system will be more affordable and less costly – but it doesn't eliminate the subsidies, which infuriates the Repealists, who want to pay for insurance for other people even less than they want to pay for insurance for themselves.

Meanwhile, the Parochialists are blanching. They cannot come out and say, "Hey, Obamacare is basically Romneycare and is the ideal Republican solution to healthcare policy and gives us everything we say we want, and we really, really ought not to fuck with it." But they see that voting for anything that actually reduces access to health insurance in their states leads to cute dead poor kids and an equally dead political career. They don't dare actually support Ryancare, because they know that anything that starts shoving people off the Medicaid rolls in early 2018 – to say nothing of the premium sticker shock that will likely result around that time from repeal of the individual mandate + retention of the pre-existing condition exclusion – could not be worse timed for their continued employment in public service.

But what they can get away with doing is pretending to be Repealists, and insisting they aren't supporting Ryancare because it doesn't go far enough. The problem with that is one of the few actual Repealists might manage to come up with an actual Repealist bill and call their bluff.

This may, come to think of it, be why there's such a rush to shove Ryancare through Congress. If it's supporters let any dust collect on it, somebody might come up with a competing, actually Repealist bill.

Right now, there are a lot of people in Congress who know that if they actually vote for this bill which will pull down the Three-Legged Stool, it will fall on top of them.

Meanwhile, there are some Repealists – I think Ryan, believe it or not, is actually a Repealist who is just much taken with his own supposed cleverness and thinks he's pulling one over on the Replacists – who are savvy enough to realize that Repeal is going to actually be wildly unpopular if it actually happens such that the public – especially the Replacists – figure out what happened and who did it to them. They support Ryancare, because they see it as slipping the Replacists a mickey, by giving them a replacement that undermines Obamacare so that it collapses. These crypto-Repealists imagine that they'll be able to escape out from under it. These people are optimists, who for their own reasons, be they good or bad, believe they can spin this in ways their political opponents won't be able to pin on them in 2018. I feel confident the Parochialists are clapping them commendingly on the shoulders with one hand and nonchalantly reaching with the other hand for their steak knives.

Meanwhile, the Replacists, whom everyone else thinks of as very slow, and not without reason, are cottoning on to the fact that as Ryancare is a really crappy "upgrade" to Obamacare. They're noticing that insurance is a hell of a lot more expensive than an iPhone, and that the people who might get kicked off of Medicaid are, well, them, and that the new tax credit scheme doesn't cover anything near what the old one does. They are also cottoning on to the fact that Ryan doesn't actually seem to care about them and their agenda. Some of them are realizing that Ryancare is most definitely not that "great" replacement that Trump promised them – and are blaming that on Ryan, to save themselves the cognitive dissonance of turning on Trump. They've been nudged along this path by Trump, who has distanced himself from Ryancare, to the extent of declining to put his name on it, which, as John Oliver pointed out [YouTube], may be the first time in his life Trump declined to put his name on something.

The Replacists seem to be on the cusp of realizing that they do not at all share an agenda with the Repealists, contrary to what the Repealists have promised them.

What the Replacists want is impossible, almost definitionally. They want something just like Obamacare, only completely different. Immediately. Their ardent desire for the unreasonable has made them easily manipulated but they're getting wise to their incipient inevitable disappointment – which will almost certainly turn into a furious backlash against a scapegoat. Ryan is looking good for that.

The Replacists have far more political clout than the Repealists, not least because a large swath of those mouthing along to the Repealist anthem are actually Parochialists who have no intention of standing by those principles – exactly to the contrary. In the 11th hour, the crypto-Parochialists will recant, getting sudden attacks of conscience, "I can't leave my trusty, hardworking, virtuous, entitled constituents without insurance, and this doesn't do a good enough job at replacing Obamacare."

The Repealists (or those whose heads aren't in the sand) know they are actually a minority whose power is largely based on their ability to set the terms for the other two factions – which is presently in jeopardy.

I wonder if we won't see a bunch of Parochialist representatives break from the party line to make a bid for the Replacist voters: announcing that they're working to come up with a superior replacement to Obamacare, unlike Ryancare, and this will take a while to get right, at least through 2018–

But moderate Republicans are balking over the CBO’s findings that millions more people would lack coverage even while premiums in many cases could rise.

In a Facebook post Saturday night, Rep. Brian Fitzpatrick, R-Pa., said he couldn’t vote for the bill, stressing a need “to take our time and to get this right.” He joins GOP Rep. John Katko, from a closely divided district in upstate New York, who cited inadequate insurance access and cost controls. [...]

Sen. Susan Collins, R-Maine, said she would not vote for the measure without additional changes to provide more aid to older Americans. She also wants an improved proposal that would cover more Americans and offer better Medicaid benefits than the current GOP plan. She joins at least four other GOP senators in opposing the bill after conservative Sen. Ted Cruz of Texas said Sunday he wouldn’t vote for it as is. Sens. Dean Heller of Nevada, Mike Lee of Utah and Rand Paul of Kentucky are also opposed.[WP]

– oh. Look at that.

I expect the more doctrinaire Repealists are basically going to declare war on these crypto-Parochialists. Don't know if that's happened yet, but the only alternative of theirs, as best I can tell, is to attempt to convince with Parochialists to ally with them, and the Parochialists all saw what they did to the Replacists, and are like, "Hahaha. I didn't fall off the turnip truck yesterday, son."

Now, I'm sure a bunch of you are wondering, "But, Siderea, does any of this mean that they won't manage to repeal or damage Obamacare?"

Alas, no. Somebody is probably going to do something stupid, possibly because they're manipulated into it, possibly because they think they're clever enough to be the exception, possibly because they drank the Repealist Kool-aid.

This is not meant as reassurance that Obamacare is safe from these fools. Just that if you enjoy seeing mean-spirited fools suffer, this is your lucky month.

Oh, and also, that this paradigm may provide some insight into how to manipulate this situation. This is eminently wedge-able. Particularly between the Repealists and the Replacists.

You know what would be awesome, Medium Game, for the Blue Nation and Obamacare? If outraged Repealists started flipping out on Replacists on Twitter, accusing anybody who espouses Replacism of being a RINO/libtard/Democratic plant/etc and attacking them for being a lazy slob who mooches off the government like those damned Democrats.

See, if someone on the Left tries to point out to a Replacist that government assistance in getting health insurance is a liberal thing, and that maybe they should come vote Democratic to get that if they want it, the Replacist will blow them off. The Replacist isn't going to listen to a Librul. The Replacist is committed to the belief that "their side" – the Republicans – can do it better and cheaper. But if someone on the Right attacks them as being "like a Democrat" for wanting Replacement, that stinging rebuke gets past their defenses and connects the idea of getting health insurance with voting Democrat.

The Replacist's immediate response to such an ideological attack is irrelevant. One might argue back defensively, another laugh it off, a third quickly disown the Replacist position to remain politically correct – but it doesn't matter what response they have: its long term effect is carving into Republican minds and culture the association of getting health insurance with voting Democrat.

Come the day that Republicans expect to be personally attacked by fellow Republicans for expressing any wish for government assistance in securing health insurance, a whole bunch of no-longer-insured Republicans will quietly cross the aisle.

I don't know that the Repealists have started doing this for us. Here's hoping.

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