Your Health May Be in Susan Collins' Hands. And That's Not Good News

Susan Collins says she's disturbed.

That's not exactly news. The Republican senator from Maine is frequently disturbed. She was disturbed by the Benghazi raid; by the Republican shutdown of the government in 2015; by the "cruel comments" of Republican nominee and now president Donald Trump; by political polarization; and most recently by Republican plans to repeal Obamacare and strip tens of millions of Americans of their health insurance.

To be disturbed when nearly all one's Republican colleagues are sanguine about injustice is not a bad thing. Collins, though, could have something to say about this last matter, Obamacare, beyond hollow expressions of concern. When the 13-man cabal of her fellow Republicans, who have been crafting a new repeal bill, finally emerges, she could announce that she will refuse to vote for any bill in which Americans would lose their insurance. She could say that Trump's cruel comments are nothing against the cruelty of putting poor Americans' lives at risk. She could say that since Obamacare provided insurance for millions, she is going to side with the Democrats against her own party.

Because Senate Republicans have only a three-vote majority margin, this wouldn't necessarily be hot air. She could say all of these things, but I would wager that she won't do any of them. In the end, Susan Collins is likely to retreat and join the conservatives in trashing health insurance.

"Polarization isn't the problem. Orthodoxy is the problem."

Of course, that is not how she is portrayed in the media. Collins is often introduced as Exhibit A of Republican moderation, a throwback to the way things used to be in Washington when the GOP had Jacob Javits, Clifford Case, Ed Brooke, Kenneth Keating, Charles Mathias, Lowell Weicker and other empathetic lawmakers in its ranks, reaching across the aisle. In truth, Collins is no anachronism. For all her apparent personal compassion, she may well be Exhibit A of what is wrong in Washington: the triumph of party ideology over common decency, conscience and even political expediency. Collins knows better than most of her benighted Republican colleagues. It doesn't make any difference.

Collins is certainly not the worst offender, which is largely the point. In fact, she may be the best of the Senate Republicans. From 1997 through 2015, she voted with her party just 60 percent of the time -- hardly lockstep.

The conservative group Heritage Action gave her only a 16 percent score last Congress, the lowest among congressional Republicans, and the American Conservative Union scored her 23 percent on bills of importance to the organization, while on the whole, Republicans averaged 75 percent. (Dems averaged 4 percent.)

Already, she has voted against Trump more than any other Senate Republican, including votes against the confirmation of Education Secretary Betsy DeVos and EPA head Scott Pruitt, and she voiced disapproval of Trump's travel ban. So what is the problem?

The problem is that Collins all too often stands up to her fellow Republicans on the small issues, while she shakes her head and frets about the big ones, only to toe the party line in the end. Yes, she wrote an op-ed declaring that she could not vote for Trump, and then said she wrote in on her ballot the name of Paul Ryan (!), one of the few party figures worse than Trump. Yes, she voted against DeVos and Pruitt, but introduced attorney general-designate Jeff Sessions at his confirmation hearings and gave him full-throated support, despite his long record of racism. Yes, she opposes Trump more than her fellow Republicans, but she still votes with him 85 percent of the time. She has a checkered record on immigration, opposed net neutrality, and got only a 38 percent rating from the Leadership Conference on Human Rights.

Newsmax CEO Christopher Ruddy, challenging the characterization of Collins as some apostate conservative, assured his readers that she is "one of us."

But it is on health insurance where Collins could arguably make her biggest political mark and establish a legacy as a defender of the vulnerable, including the vulnerable among her own constituents, who have benefited enormously from Obamacare in a state that has the oldest population in the nation. But don't hold your breath. Collins has been as doggedly resistant to Obamacare as any Republican. She voted against Obamacare in 2009 and then against the Senate-House reconciliation act. She voted for repeal in 2011 and 2015 and again this past January.

When her fellow Republicans shut down government in 2013, insisting that they wouldn't approve funding without an Obamacare repeal, she claimed, disingenuously, to have bucked her party. What she really did, according to Mother Jones, is vote three times to keep the government running but if and only if Democrats defunded or delayed Obamacare.

"There is no denying that the Affordable Care Act has made insurance available to millions of Americans and allowed people to leave corporate jobs and start businesses," she told The New York Times. But Collins claims that she worries about instability in the health markets, rising premiums and the dearth of facilities in Maine -- all of which might be legitimate concerns if the instability of the markets wasn't largely the result of Republican sabotage, if premiums had risen anywhere near as much as critics contend, and if access to facilities had anything to do with Obamacare. Oh, and one more thing. Collins opposed Obamacare before it was implemented, so none of these criticisms makes much sense.

To shore up her moderate credentials, Collins, who opposed the House Republican bill, has introduced her own replacement bill along with Louisiana Republican Bill Cassidy. She calls it a "compromise," but it is clever window-dressing. Its big features are Health Savings Accounts instead of direct subsidies, a Republican panacea for all ills, and waivers for states to construct their own insurance systems. Without getting into details, the first has been largely discredited as a sop to the wealthy, since everyone knows Republicans would never adequately fund these accounts, and the second is already a feature of Obamacare as well as an exit strategy for Republican governors.

"The Republican health plan may be top secret, but their real motives aren't."

Meanwhile, Collins has said she agrees with a letter signed by Republicans Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Linda Murkowski of Alaska promising not to support a plan that "does not include stability for Medicaid expansion populations or flexibility for states" -- two things that might very well be mutually exclusive. In any case, I wouldn't bet on them following through on the threat.

None of this is to pick on Collins. Rather, it is to state the unfortunately obvious. Republicans are likely to pass a repeal bill with weak provisions for existing conditions and no provision for long-term Medicaid. It is almost certain to receive the votes of the entire caucus -- yes, every last one, including Collins, unless Rand Paul, who opposes government insurance of any sort, sticks to his guns. And it definitely will not be an attempt to improve upon Obamacare, as we so often hear, but to remove it.

The Republican health plan may be top secret, but their real motives aren't. What Republicans want, what they lust after, is to destroy Medicaid and any government effort to aid the vulnerable while wiping their fingerprints from the scene of the crime. This has never been about policy. This has always been about an unholy blend of ideology and partisanship -- an ideology that boasts about harming the powerless to fellow conservatives and a partisanship that opposes anyone who tries to help the powerless.

Collins talks a good game. She said she came to politics when, as a high school student, she visited Maine's Republican Sen. Margaret Chase Smith, who gave her a copy of a 1950 speech in which Smith lacerated red-baiting Sen. Joseph McCarthy for relying on the "four horsemen of calumny -- fear, ignorance, bigotry and smear." Smith called it her "Declaration of Conscience," and it dealt a blow against McCarthy when others were loath to do so.

Conscience is in short supply now, and Collins sadly hasn't exhibited much, her exemplar notwithstanding. Every major medical organization opposes Obamacare repeal. So does every organization that represents the aged, the sick and the poor. According to The New York Times, the majority of every single state opposes it, so there is no political gain, other than the gain of appealing to the worst elements of the party and the country. Everyone knows that lives are at stake. And yet, Republicans are determined to eviscerate health insurance, regardless of the political consequences, which could be severe.

As for Collins, she would probably not face any consequences at all were she to demonstrate a conscience like Margaret Chase Smith's. Even if she were "primaried" from the right -- that great terror among Republican incumbents -- she would almost certainly win, and in any case, she reportedly is considering a run for governor.

So: If not now, when? If not on this issue, on which? If not her, who? The answers are likely never, none and no one. The best, indeed, "lack all conviction," as Yeats wrote.

And that is why the ever-disturbed, much-dismayed Susan Collins is an object lesson in the failure of our politics. She will express her concerns. She will propose empty compromises. She will take no evident joy in hurting the defenseless like most Republicans. But in the end, even when the country is nearly uniform in opposition, she will fall in line because that is what Republicans always do, if only to prove they don't have bleeding hearts, or any hearts at all.