Jay Bookman

Opinion columnist and blogger with The Atlanta Journal-Constitution, specializing in foreign relations, environmental and technology-related issues

Opinion: Winners in 'health reform' probably don't include you

House Republicans are having a tough time passing a health-care "reform" bill that guts Medicaid by cutting $880 billion, that pushes an estimated 24 million Americans off their health insurance plan with no replacement, that hits poor, elderly and rural Americans hardest and that hands most of an $880 billion tax cut into the hands of wealthiest Americans. It's no surprise that passing such a bill is difficult.

No, it's the reason they can't pass the bill that gets to me. They are having trouble corralling enough Republican votes for a Republican bill to keep a Republican promise to the Republican base because in the eyes of many Republicans, the bill simply is not mean enough. It doesn't cut enough, it doesn't punish enough, it doesn't do more to make the vulnerable and fragile in our society even more vulnerable and fragile.

That's the part that gets to me.

The GOP effort is being led by President Trump, the man who campaigned as the anti-elitist champion of Americans who feel left behind, who told voters that unlike Paul Ryan and other Republicans, he understood the necessity of preserving the safety net and would never allow cuts to Medicare, Medicaid and Social Security.

“We’re going to have insurance for everybody,” Trump used to say.  “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

Once in office, though, Trump has distanced himself from that position faster than you can say "Who's Paul Manafort?" To his voters, such talk may have been reassuring, a sign that their hero really truly cared about them, but it's now clear that to Trump himself, such promises were merely a means to an end, a way to fool the rubes long enough to get the ultimate personal validation that he craved and that the presidency represents to him.  Indeed, with House conservatives demanding that the original "repeal-and-replace" bill be made even tougher and meaner to get their vote, Trump this week has happily, readily agreed, apparently heedless of its impact on real people.

And why?

In his speech Monday night at a rally in Kentucky, he told us why. He told us why repeatedly.  Over and over again, he told the crowd, he wanted to get the health-insurance bill "passed in some form so that we can pass massive tax reform, which we can’t do until this happens. We’ve got to get this done before we can do the other. In other words, we have to know what this is before we can do the big tax cuts."

"Thursday is our chance to end Obamacare and the Obamacare catastrophe and begin delivering the reforms our people deserve," he said. "Big thing.  Then we get to tax cuts.  Big thing."

His supporters cheered at that too, at his promise "to massively reduce your taxes."  What Trump didn't tell them is that he personally, on his own, would almost certainly reap more financial benefit from those tax cuts than everybody else in that audience put together -- that is, unless there happened to be a few other billionaires in attendance. Just one of the changes sought by Trump and his fellow Republicans -- elimination of the alternative minimum tax -- would have cut his 2005 tax bill from $38 million to $7 million, a one-year savings of $31 million. Elimination of the estate tax, another treasured GOP goal, would save Trump's children as much as $4 billion.

It's a shell game, a game in which the con man's well-honed patter distracts you from what he's doing to you right in front of your eyes. And it's dismaying how many people still refuse to see it.



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About the Author

Jay Bookman writes about government and politics, with an occasional foray into other aspects of life as time, space and opportunity allow.