The GOP’s medical credo: ‘First, do harm’

So here we go again with the Republican quest to wreck the health care coverage of tens of millions of Americans. If you’re sick of reading about the GOP’s undead obsession, rest assured that I’m sick of writing about it.

But let’s try to solve a mystery.

The details of the latest Senate mission, known as Graham-Cassidy, are not worth parsing; suffice it to say, they’re roughly similar to all the party missions that died this spring and summer. The current bill, which has speedily gained strength like a hurricane bearing down on the Caribbean, checks all the heartless Republican boxes: It basically aspires to cancel Obamacare’s expansion of Medicaid (thus imperiling 14 million people who’ve gained health coverage), and cede health care policy to the states by giving them a modest chunk of federal money to use – or not use – Key Obamacare requirements would be erased; for instance, the states would be free to let the insurance companies slap higher premiums on people with preexisting health conditions.

And rather than bore you with the parliamentary details, suffice it to say that Senate Republicans are anxious to pass this thing by Sept. 30, because under the rules of “budget reconciliation” (which expire on that date), they’ll need only 50 votes plus Mike Pence. They’re rushing toward passage before most Americans wake up to what they’re doing, and before the nonpartisan Congressional Budget Office has sufficient time to “score” the likely human toll.

Bill Cassidy of Louisiana, one of the co-sponsors, said back in March that the responsible move, when dealing with one-sixth of the economy, is to wait for a CBO report (“You have to have an umpire…I am very reluctant to disregard what the CBO score is”), but naturally, now that Republican desparation is at fever pitch, Cassidy has become the poster child for hypocrisy.

And virtually all of his fellow Republican senators seem to care not a whit that this last-ditch bill is being opposed by (among others) the American Medical Association, the AARP, the American Heart Association, the American College of Physicians, the American Academy of Pediatrics, and at least five Republican governors who care a great deal about their affected constituents.

The mystery – remember, I promised you a mystery – is why the Republicans remain so determined to wreak havoc with the lives of the sick, the elderly, the underpaid, and millions more. After multiple failed attempts, why are they so compelled to disgrace themselves yet again?

I have four theories, all of which overlap:

1. They’re bound in servitude to The Base, and they’re terrified that if they don’t deliver on their longstanding promise to destroy President Obama’s health care law, that The Base will stay home on midterm election day, thus enabling Democrats to retake the House in 2018. David Brat, a Virginia congressman, said recently, “If we don’t (kill Obamare), none of us are coming back.” And so the Republicans keep trying, if only to demonstrate that they haven’t entirely given up. They don’t even bother to promise anymore that Republican “reform” would deliver broader coverage at lower prices. Nobody is making that case for Graham-Cassidy. All they want now is something they can spin as a Win.

2. They’re trying to please Trump; more precisely, they want Trump to stop making fun of them. For months he has mocked their legislative failures (even though his failure to lead and his ignorance of policy have made things worse), and they’re sick of reading those tweets. They’re upset that Trump has been dealing with Democratic leaders, so they’re desperately jonesing to give him any Win whatsoever, even a Win that screws tens of millions, in order to get back in his good graces.

3. They’re hewing to their right-wing ideology, which is Robin Hood in reverse. The way Graham-Cassidy is structured, it would potentially save billions of federal Medicaid dollars. According to the Republican mindset, that would be awesome because those budget savings could help finance the massive tax cuts that Republicans hope to bestow on the millions of comfortable Americans who don’t need tax cuts. (That’s the GOP definition of tax “reform.”)

4. They’re trying to please the Koch brothers, and the network of rich donors who take cues from the Koch brothers. They dearly want the Koch network’s money for their ’18 midterm campaigns. And lest we forget, the Koch network warned a few months ago that if the Republicans failed to destroy Obamacare, the piggy bank would be sealed. One Texas-based donor told the GOP, “Get Obamacare repealed and replaced, get tax reform passed. Get it done and we’ll open it back up….we’re closing the checkbook until you get some things done.”

So the question is whether a small but pivotal number of Senate Republicans – Lisa Murkowski and Susan Collins again? John McCain again? – will defy the political pressure and stand up for the welfare of millions. Will Rob Portman of Ohio vote Yes to destroy people’s health care when the Ohio governor of his own party has signed a bipartisan letter urging No?

Are these people really as tribal and craven as they appear to be? Yes, most of them are. One GOP reportedly laments, “You could do a post office renaming and call it ‘repeal-replace’ and 48 Republican senators would vote for it sight unseen.” But when crunch time arrives next week, will there be 50? As Trump would say, “Stay tuned.”

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