Somebody should issue a health advisory. It’s hard to watch the tortured gymnastics of American senators and congressmen as they twist and turn over the subject of healthcare and not believe one or most of them won’t herniate something before they’re done. Those claiming to support the new healthcare bill want it to fail the most, and those that are appalled by the bill are those that stand to gain if it succeeds. Confused? Don’t worry. There’s very little about American healthcare that makes much sense.

The problem here is that there are really two realities; two prisms through which you can view the current battle. The first prism is that of what’s best for Americans. To the more ideological conservatives such as Rand Paul, the best thing for Americans is to repeal entirely Obama’s healthcare act (sometimes called Obamacare but properly called The Affordable Care Act). These are the small (to the point that it’s non-existent) government conservatives to whom everything must be optional. The less ideological conservatives — that is, the bulk of the Republican party — believe in something less than this green prairie, shoot your own bear, my land/my laws absolutism. They can see a path to supporting the replacement. Lastly on the Right, we have the Trumpians, though they don’t make up any sizable caucus inside the Senate or House. In fact, we really just mean the President. He support the new bill because it’s what he campaigned on. It’s what he promised to do.

Democrats, of course, support Obamacare and believe the Congressional Budget Office’s assessment that the American Heath Care Act (the name for the GOP’s replacement of the Affordable Care Act) will save the government $337 billion within a decade but at the cost of 14 million people losing their coverage. They are solidly locked into opposing any changes but, without majorities in either the House or the Senate, are really cut out of the debate for the moment.

This description broadly covers the basics of what’s currently being discussed. This prism is really the world as we know it. This is where people’s lives will be affected and the heath of Americans decided for at least a generation.

Yet viewing Washington through this prism doesn’t really reveal what’s actually going on. View the world through the second prism and you see what’s best for the politicians. That’s where you see the gymnastics and begin to hear the cracking of bone and the tearing of muscle.

You see, what is probably best for the Democrats in terms of their election strategy is for the American Health Care Act to pass through the Congress and enter into law. This will be immensely painful to many Americans, especially those at the lower end of the income scale. Many of these people voted for Trump. They are the proverbial turkeys that voted for Christmas. They will have their healthcare ripped from them, along with all the other social benefits that will disappear under Trump’s bombs-over-ballet budget. Come the next election, these are the people who will suddenly see the appeal of the Democratic vision.

What’s best for Donald Trump? Again, probably the opposite to what he’s now supporting. (Among the very few moments when he’s said something that’s actually true is when he’s admitted that the best thing he could do would be to allow Obamacare to fail.) Trump succeeds so long as he cannot be held responsible for anything. He might take credit for job growth and the state of the economy but, thus far, he’s enjoying the Obama legacy. His problems really begin the moment he can no longer stand before crowds and lament Obamacare. He really needs his own healthcare proposals to fail, probably in the Senate, allowing him to blame those Republicans who never really believed in him in the first place. He will tell his voters that he’s still the outsider, still struggling to fight for them against the elite establishment of Washington.

What’s best for Paul Ryan? Here the gymnastics start to involve a twists in addition to the flips. There’s currently a squabble going on between the White House and the Hill over who takes credit for the new healthcare act. It was apparently President Obama who suggested to Democrats that they give the American Heath Care Act the catchy name ‘Trumpcare’. It was a good suggestion. Donald Trump apparently hates the word. Trump wants it called ‘Ryancare’.

Childish? Of course it is but the stakes are high. If Ryan wins and Trump is credited with the new healthcare act, then traditional conservatives can distance themselves from what has become something of an albatross around their necks for the past decade. Trump fails and the traditional wing of the party re-establishes itself. The failure of Trumpcare would merely be the latest of the many failed ventures to carry the Trump name. Trump Steaks, Trump University, Trumpcare… Yet if it becomes known as ‘Ryancare’ then the President is again strengthened and it affords Trump the opportunity to continue to do what he does so well: deflect criticism and succeed by doing nothing more than tread water.

So much of this has to do with ‘optics’, that is, how politics are perceived rather than the practical improvements they make to people’s lives. Obamacare has never had great optics, even as it succeeded in giving many Americans the health coverage they needed. Trump, on the other hand, is a master of optics, despite the realities he oversees being less impressive than he claims. This is the great undercurrent to the current debate. The Republicans ideally need Obamacare to fail, so they can claim victory when it does. The Democrats need the Republican plan to move ahead so they can justifiably argue that they were right all along and did something that materially improve healthcare for everyday Americans.

It’s all smoke and mirrors and real people’s lives.



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