Why the Obamacare Repeal Effort Will Not Die, No Matter What

If you want to calibrate just how bad the Senate Republican health care bill is, you don't need the Congressional Budget Office telling you that 22 million Americans would lose their insurance. Look no further than Susan Collins. The bill is so god-awful that the Republican senator from Maine, whom I lacerated last week for always fretting and dithering over her party's initiatives only to support them in the end, wouldn't even vote to bring it to the floor.

Of course, Collins being Collins, she says she is open to negotiations, and I suspect Senate Majority Leader Mitch McConnell will make a concession on Collins' precious Health Savings Accounts. Whether the opposition of Collins and others ultimately sinks the bill remains to be seen, though I wouldn't count on it. The vote postponement notwithstanding, Republicans being Republicans are going to resurrect it with nips and tucks for many more go-rounds, since Republicans are absolutely determined to savage Medicaid and ultimately destroy it. Stay tuned.

Since the vast majority of the public loathe the GOP bill, and since it has been universally panned in the media and by just about every stakeholder, you have to wonder how the GOP can keep flogging it. The answer is that they clearly feel there will be no political consequences for doing so, and they may be right. Republican Dean Heller, who came out against it this week, represents Nevada, a blue state with a heavy Medicaid enrollment, so he is unlikely to be wooed, but among Republicans running in 2018, he is virtually alone. (He was not spared, however, from attacks from a Trump super PAC, and he is almost certain to be primaried from the right.) No one else in the party seems to fear retribution as much as they fear bucking conservative ideology.

Take West Virginia. Thirty percent of West Virginians -- some 554,000 people -- are dependent on Medicaid, which the Republican Senate bill will effectively decimate, and the state has a serious opioid problem, which Obamacare addresses. Still, West Virginia gave Trump, who campaigned on the promise to repeal Obamacare, a whopping 42-point margin of victory, and there isn't a snowball's chance in hell that it will vote for a Democratic presidential candidate in my lifetime.

Or take Kentucky. Out of a population of 4.5 million, 1.3 million are on Medicaid. And yet its senior senator, McConnell, is the architect of the plan to reduce Medicaid, and the state's other senator, Rand Paul, has no qualms about saying he wants to destroy Medicaid altogether. Once again, there isn't a snowball's chance in hell that either McConnell or Paul will lose re-election.

Politics is supposed to operate on the principle that if an officeholder works against the interest of his or her constituents, those constituents will take revenge by booting him or her out of office. That's just common sense. And it's also common sense that health care should be a prime consideration for those constituents. When Republicans propose huge tax cuts for the wealthy while simultaneously cutting health benefits for the poor and the working and middle classes, or when they propose a bill that drives up premiums and deductibles while shredding the safety net, the logical result would be a revolt. Instead, these folks keep coming back to the party, which is why the GOP can keep coming back to its Draconian health care plan.

How do you parse this? You could say that people don't understand their self-interest very well, and there is certainly some truth to that. A Kaiser Health poll shows that a bare 51 percent of Americans now support Obamacare, which is a high-water mark, while 74 percent have a favorable view of Medicaid, the very linchpin of Obamacare. That suggests they don't understand how inextricably Obamacare and Medicaid are bound.

Or you can say, as I wrote here, that many of these folks believe in stripping government benefits from the seemingly undeserving, even if doing so hurts themselves.

Yet it isn't the economy, stupid, or health care reform that drives these voters to Republicanism. It is their perception of the march of history. They have come to believe that they are a persecuted white majority, and that grievance supersedes everything else, including their own health insurance. Republicans count on that.

Three recent surveys support this explanation. One, a recent post-mortem of the 2016 election by the non-partisan Democracy Fund Voter Study Group, reports that Trump's vote, especially among whites, had far less to do with economic distress than with nativism, racism, sexism and Islamophobia -- what you might call cultural distress.

Another analysis conducted by the Public Religion Research Institute (PRRI) and The Atlantic magazine also found that economic distress did not correlate with Trump support. In fact, it was the opposite: "Those who reported being in fair or poor financial shape were 1.7 times more likely to support Clinton, compared to those who were in better financial shape." But those who felt culturally dispossessed and felt that the country needed to be safeguarded against immigrant invasion were 3.5 times as likely to support Trump as those who felt differently.

If you still don't think that lots of working-class white Americans feel culturally aggrieved, consider another survey in February by PRRI finding that white evangelicals believe Christians are more discriminated against in America than Muslims, with 57 percent asserting "a lot" of discrimination against Christians.

This jibes with an earlier study from Michael Norton of the Harvard Business School and Samuel Sommers of Tufts that showed deep white belief in "reverse racism" coupled with the belief that African-American gains come at the expense of white losses.

On its face, of course, this is absurd. There is virtually no metric -- be it education, wages, wealth, social mobility or health -- in which African-Americans have it better than whites. (I won't even address Islamophobia versus an animus against Christianity because it is beyond absurd.) But we now generally accept that many whites, especially older, uneducated and religious whites, believe -- not entirely without justification -- that they are on the wrong side of history. Everything seems to be moving against them and against the dominance they once asserted, and to them, America seems cleaved between a halcyon past and a foreboding future, which may be the real division in America that subsumes so many others.

This sense of dispossession is the what sociologist Arlie Russell Hochschild calls the "deep story" -- the story told by one's feelings as opposed to the story told by the facts. In her book, Strangers in Their Own Land, Hochschild writes that working-class Republicans' deep story is one of betrayal, neglect, disrespect, suspicion and unfairness.

Such cultural disaffection is what our ahistorical president preys upon. He promised that he would push back history, that he would rescue whites from immigrants and minorities and women and intellectuals and homosexuals. He promised that he would restore the America they believed they had lost.

"Make America Great Again" is a euphemism for "Make America White Again." It is no coincidence that Trump's most enthusiastic supporters are white, male, uneducated and evangelical -- people for whom history is moving in the wrong direction. They are Trump's political superfecta.

Which brings me back to the health care bill. The Obamacare repeal effort has always functioned on two levels: the practical and the symbolic. On a practical policy level, Obamacare repeal was never particularly realistic. The original bill had been compromised and jiggered about as much as one could possibly do in an effort to build a government/market hybrid, so the idea of jiggering it any more without just scrapping it for single payer was highly unlikely to make it more effective. After seven years, the only thing Republicans can seem to come up with is undoing Obamacare without really replacing it.

But you could only let it lapse and throw those 22 million off insurance if you were confident the symbolism would supplant the practicality, that it was more important for those beneficiaries of Obamacare to score a victory against the encroaching forces of cultural liberalism than to get decent health care. Symbolically, Obamacare represented change, government interference, social engineering by pointy heads and uncertainty. It was yet one more thing that would push the glorious past farther away.

There is a strange poignancy in this. People will continue to vote enthusiastically for the party that will strip them of their health care so long as that party promises to turn back the clock. So we will get another GOP health care bill and another and another until one finally passes, as I am fairly certain it will. And when it does, the congressional Republicans and their addled president can rejoice because whatever price their constituents pay, they themselves will pay none.