This week, the Congressional Budget Office weighed in on the American Health Care Act, the House GOP’s proposed replacement for Obamacare. What the CBO described is quite simply a humanitarian catastrophe: 24 million people without health insurance, all to pay for massive, mostly upper-class tax cuts. If it or anything like it is enacted, it would be one of the worst statutes ever passed by the United States Congress. It’s tempting to blame the voters who put Republicans in power for this perilous situation. But their confusion about health care stems from many sources, including President Donald Trump, but also his fellow Republicans, Democrats, and the mainstream media.
You certainly can’t call the AHCA a pander to the Republican base. As Brian Beutler observes, the older white rural voters who were crucial to Trump’s Electoral College majority will be absolutely brutalized if the AHCA passes. The savage proposed cuts to Medicaid would affect a lot of Trump voters in purple states that accepted an expansion of Medicaid under Obamacare. The AHCA’s less generous and less egalitarian subsidies would also essentially lock out non-affluent voters who are close to retirement, but too young to qualify for Medicare, from the individual insurance market. If House Speaker Paul Ryan gets his way, a lot of Trump voters who trusted Republicans to protect or improve their health care will suffer physical and/or financial ruin and in some cases avoidable death.
Given that marginal Trump voters in key states will be hit hard unless the AHCA can be stopped, these voters have been the subject of scorn. And, yes, voters have agency and have to take responsibility for their choices. But before we rush to criticize ordinary voters who were conned, we should consider the massive failure of American elites to inform them during the 2016 campaign.
This should start at the top. Trump’s approach to health care policy during the campaign was one he has applied to all fields: that is, to lie constantly. Trump explicitly promised that there would be “no cuts” to Medicaid, which TrumpCare would in fact cut big league. He also promised “insurance for everybody” and repeatedly asserted that this insurance would be better than Obamacare. Needless to say, under TrumpCare many fewer people would have insurance and the quality of insurance people could afford would more likely be worse than better.
Perhaps you could argue that anyone who trusts a liar as
prolific as Trump gets the government they deserve. But it wasn’t just Trump. As
Eric Levitz at New York magazine demonstrates,
Republicans in general lied systematically about their plans for health care. As
recently as January, Republican ads were cynically attacking Obamacare from the
left, arguing (correctly!) that health care costs were too high and that plans were
too expensive and not generous enough. Republicans were very careful not to be
explicit about their plans to take away the health insurance of tens of
millions of people to pay for tax cuts for the extremely affluent. It’s unfair
to put more blame on the marks than on the deceitful con artists who ultimately
offered them an egregious bait-and-switch.
If ordinary voters can’t be expected to have the background knowledge to see through the Republican health care fraud, surely political journalists can. And yet the media failed completely to adequately convey the policy stakes of the 2016 election. An ordinary voter could have no idea what to reasonably expect from Trump and a Republican Congress even if they made an honest effort to follow news about the election.
Mainstream media outlets mostly abandoned policy coverage during the 2016 elections. Network newscasts devoted exactly zero minutes of coverage to health care policy between January and late October of 2016. Only one question about health care was asked during the four presidential debates. A comprehensive study by the Shorenstein Center found that only 10 percent of media coverage of the campaign focused on policy. And much of that small fraction was devoted to Trump’s unorthodox stances on a few issues like trade, which could well have reinforced Trump’s false promises on health care, framing him as the kind of Republican who wouldn’t gut grandpa’s Medicare.
It’s not as if the Republican plans were a secret. They had passed numerous bills to repeal Obamacare when Obama was in office, and the effects of such repeals had been estimated.
And it’s even worse than that. While the media was mostly ignoring literally life-or-death issues like health care and climate change, it was providing voters with wall-to-wall coverage of one “issue”: Hillary Clinton’s email server. The bizarre saturation coverage of this trivial pseudo-scandal helped convince much of the public that Clinton was just as dishonest and corrupt as her opponent—a serial liar who refused to release his tax returns and has used the presidency to enrich himself on an entirely unprecedented scale. It also provided the ammunition FBI Director James Comey used to deliver the kill shot to Clinton’s campaign: the October letter to Congress announcing new alleged revelations about the server, which contributed to a significant late surge for Trump in battleground states.
The Clinton campaign is not blameless here, either. Admittedly, conveying the dangers of Republican policy proposals in a media environment that was both uninterested in policy coverage and fixated on Trump’s every utterance was a very difficult challenge. (Clinton got barely more coverage than Trump during the Democratic National Convention.) Clinton’s advertising campaign focused almost entirely on Trump’s character and said almost nothing about policy. Whether a greater focus on the dangers of Republican government would have changed the outcome of the election is unknowable, but Clinton should have made a greater effort to fill the void left by the media.
The fact that a lot of Trump voters will suffer if the AHCA passes is not an occasion for schadenfreude. It’s horrifying. And before you rush to blame them, blame the elite public officials, candidates, and institutions that completely failed to present them with an informed choice during the 2016 campaign.