Should-Read: Mike Konczal: Four Lessons from the Health Care Repeal Collapse

Should-Read: Mike Konczal: Four Lessons from the Health Care Repeal Collapse: “I [had] thought President Trump would sign a reconciliation bill gutting the Affordable Care Act (ACA) by the time Congress took their February recess…

…They didn’t…. The failure of their plan was so ultimate and total it still surprises me….. Here’s how I’m updating my thoughts so far…. (1) This is not President Trump’s fault: A President Rubio or President Jeb! would have had the same exact problems with the same exact outcome. This was driven by Congress, and it derives from the initial strategy of “repeal and delay” collapsing immediately and the backup plan not being tested…. I didn’t expect the eventual bill to be a mess that appeased no one because I assumed there was a concrete bill…. There was no plan, and the attempt to force one was dangerous and reckless.

(2) Activism Works:…. Hard ideological movement to the right and a massive funding network post-Citizens United had me worried that the Right would happily march off an electoral cliff to take away health care from millions of people…. The moderates chose not to support the bill, [so] the GOP was forced to rely more on the hard-liners, who didn’t show up. Activists got to those moderates… by forcing them to accept continuity with the ACA, to acknowledge the coverage numbers mattered, and by getting them to defend Medicaid. They did that by demonstrating how these programs benefited them….

(3) Universalism Works: Hell yeah it does. I already thought this but it is humbling to see the concept reveal its awesome power. I assumed… Medicaid was going to get trashed…. When I learned how Medicaid cuts would be turned into a first round of high-end tax cuts, ones that would prime the pump for permanent high-end tax cuts later, I thought it was in even more trouble…. I was wrong, and the expansion of the program to people above poverty saved it….

(4) Wonks Get Lost in Their Echo Chambers:…. It’s crazy to come into an argument that’s already going, and seeing conservatives who were supposed to be the intellectuals convince themselves of the most absurd statements. Take this, from AEI’s “Improving Health and Health Care: An Agenda for Reform,” a defining statement by 10 policy writers:

The central focus of the ACA and, in fact, the central focus of many health care reform efforts has been to decrease the number of Americans without health insurance protection. […] But this near-exclusive focus on health insurance is also ironic because, in truth, consumers generally are not all that interested in health insurance. What they care about is better health and access to care. […] that means promotion of more direct and more flexible methods for purchasing services [like health savings accounts].

What has happened where you have “in truth, consumers generally are not all that interested in health insurance” as a defining health care statement that you use to guide the entire Republican establishment?… Was this meant to tell the GOP that they can ignore a bad CBO analysis? I can tell you that out in the real world people are very sensitive to whether they have insurance…. How did Republicans end up in this position where ideas that should function as a railing and guide end up speaking to nobody? McKay Coppins wrote that recent changes have led to “a caucus full of conservatives with excellent ratings from the Heritage Foundation, and no idea how to whip a vote” in Congress. The DC conservative policy apparatus has followed a similar path. It have also become accountable only to itself, ideological donors, polarizing media, and a race against their own extreme instincts. It’s the dynamic David Frum diagnosed in his classic Waterloo essay, but among the intellectual class as well…