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On health care, the GOP literally doesn't know what it's doing

Republicans aren't just getting the substance of health care wrong. They're also too lazy to care.
The dome of the U.S. Capitol Building is reflected in a puddle on a rainy morning in Washington.
The dome of the U.S. Capitol Building is reflected in a puddle on a rainy morning in Washington.

A Bloomberg News report noted in passing yesterday that Senate Republicans are gearing up to pass a sweeping health care overhaul, but they're also "still trying to figure out what it's in the bill." It was practically the basis for an awkward joke: the GOP lawmakers who are ready to cast one of the most important votes of their careers are the same Republicans who have no idea what they're voting on.

And I mean that quite literally. Vox asked nine GOP senators yesterday to explain why Graham-Cassidy is a worthwhile proposal, and not one of them could come up with a good answer. Asked how the health care system would be better under this proposal, Sen. Pat Roberts (R-Kan.) replied, "Look, we're in the back seat of a convertible being driven by Thelma and Louise, and we're headed toward the canyon.... So we have to get out of the car, and you have to have a car to get into, and this is the only car there is."

Axios reported this morning that Republicans have adopted a "Repeal first, ask questions later" posture.

Senate Republicans are on the verge of passing a sweeping health care bill not only without knowing what's in it, but without particularly caring. The political abstraction of "Obamacare" -- and the seven years of promises to "repeal Obamacare" -- have almost totally overshadowed even the broad strokes of policy, much less the details. [...]"I am just in shock how no one actually cares about the policy any more," one GOP lobbyist told [Axios' Caitlin Owens].

A senior GOP aide added, "If there was an oral exam on the contents of the proposal, graded on a generous curve, only two Republicans could pass it. And one of them isn't Lindsey Graham."

Graham, of course, is one of the ostensible co-authors of the Graham-Cassidy plan that's likely to get a vote next week. (At his bill's unveiling, Bill Cassidy referenced actuarial values. Graham, demonstrating his interest in policy details, told reporters, "I've had to listen to this crap for two months.")

Health care policymaking is difficult and requires policymakers to consider all kinds of complex variables and trade-offs. The consequences of the decisions couldn't be more important: not only are we talking about matters of life and death for millions of Americans, but this is also one-sixth of the world's largest economy at stake. This is no place for casually approving radical changes.

But Republicans, proving my post-policy thesis in ways even I find terrifying, don't seem to care about any of the details or how they might affect American families. GOP lawmakers aren't just getting the substance wrong; they're also lazy.

These officials are paid quite a bit of money to do an important job -- shaping federal policy for the planet's most dominant superpower -- and by all appearances, Congress' Republican majority doesn't feel like doing that job responsibly. Someone will put a bill in front of them, call it "repeal and replace," share a few bumper-sticker slogans, and they'll vote "aye" without a whole lot of thought.

If tens of millions of Americans are punished in the process, so be it. Their goal is to check a box, not to protect your interests.

I made the case yesterday that the public has no idea why Republicans support this regressive approach to health care, but as GOP lawmakers are helping prove, Republicans themselves have no idea, either.

What matters most, of course, are the outcomes for the public, but before Americans feel the brunt of the GOP's policymaking, consider what this dynamic means for the process in the institution that was once known as The World's Most Deliberative Body. Senate Democrats could (and likely will) make a clear and convincing case against Graham-Cassidy to their Republican counterparts, explaining why it's an awful plan that would cause widespread suffering if it were implemented. What's more, those Democratic arguments would be rooted in fact, evidence, and reason.

But the asymmetry between the parties suggests it wouldn't make any difference. Because for many Republicans, whether a bill is sound on the merits is far less important than whether it's a Republican bill. There's no meaningful connection between the value of an idea and GOP lawmakers' willingness to support it.

Policymaking in the United States can't, and won't, work this way. History will be merciless.