The Corner

Politics & Policy

How the Logic of Tribalism Is Driving the Health-Care Debate

I’m just thinking out loud here. But it seems to me this is one of those moments in American politics where no one can simply say what they really think or want. As Yuval noted yesterday, big chunks of the GOP-controlled Congress just don’t want to deal with health care or repeal Obamacare. As both the House and Senate legislation demonstrate, they’d rather tinker with it than tear it down. But they can’t say that. So, they’re claiming this is a repeal of Obamacare. It’s not. But it is a repeal of the Medicaid expansion that was glued onto Obamacare.

This is odd in many ways. Donald Trump vowed not to touch Medicaid. He also doesn’t seem to like either bill on the merits, but he desperately wants a big legislative win and the ability to say he repealed Obamacare. So, in policy terms, the voters who believed Trump when he said he wouldn’t touch Medicaid are getting screwed, but it seems many of them — or their anointed representatives in right-wing media — don’t care, because they too want Trump to have a big political win more than a much more difficult policy win (and for the Democrats to have a big political loss).

Meanwhile, the Democrats know that Obamacare has been a huge albatross for their party and understand that the best thing that could happen for them is if the Republicans agreed to keep Obamacare in name (i.e., abandon the rhetoric of “repeal”) but do whatever is necessary to make the thing work. But the GOP is doing the opposite. It’s largely keeping Obamacare in terms of policy (at least the really popular parts) but rhetorically its claiming to destroy Obamacare utterly. So, both the Democrats and the Republicans end up claiming this is a repeal of Obamacare when it’s not. It’s all a war for the best spin, not the best policy.

In different times, a Republican president might have come in and, like Eisenhower did with the New Deal, say, “We’re not going to throw away all that stuff, but we are going to fix it and shave the rough edges off.” A mend-it-don’t-end-it rhetorical approach to Obamacare would win over enough Democrats and moderate Republicans to pass a serious (albeit way-too-statist for me) health-care bill that gave Obama credit while reworking the whole thing.

But in our universe both sides are locked into psychological positions and they cannot stomach the idea of not winning the zero-sum rhetorical war of “we won and they lost!”

I’m not saying that alternative universe would be better. For instance, I wish Eisenhower had been more hostile to the New Deal. But I do think it’s an interesting example of how rhetoric and the logic of tribalism is driving the debate far more than policy is.

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