For seven years, Congressional Republicans promised every day to repeal the Affordable Care Act. Again and again, they pushed futile repeal bills, stalled important legislation, and even shut down the federal government in their efforts to avert the coming doom that Obamacare would surely bring (quick side note: In case anyone is still confused, the Affordable Care Act and Obamacare are the same thing, and the threatened apocalypse hasn’t occurred as of the date of this writing – unless you consider an additional 20 million people getting health insurance apocalyptic).

As part of their fire-and-brimstone protestations, Congressional Republicans promised that they could easily replace the ACA with something infinitely better – a plan that would be great for business, and somehow also insure even more Americans, with even better care, for even less money. On the campaign trail and since his election, Donald Trump promised that this new plan would cover everyone, would be totally affordable, and nobody would even have to lose coverage, switch plans, or change doctors. Sounds great, right? If they could just get the ACA out of the way, Republicans could transform the American healthcare system into a shining beacon of both robust capitalism and robust personal health.

Unfortunately for Congressional Republicans, they now unexpectedly find themselves in power, faced with the prospect of actually delivering on all those feverish promises. It hasn’t gone well so far. At first, the mythical near-perfect Republican healthcare plan, which the GOP had seven years to develop, couldn’t be found. Once it was located, it was announced to little fanfare -almost as if Paul Ryan & Company were embarrassed by what they were revealing. Even Trump, well-known for his compulsion to splash his name in huge gold letters on everything in sight, instead offered a lukewarm response that suggested he would rather stay on the fence for now.

If the GOP was embarrassed to reveal their proposed ACA replacement, they were right to be. The American Health Care Act (AHCA) is a heartless, incoherent mess of a plan that would kick tens of millions of people off their health insurance plans and impose tremendous risks and costs on American families. Insurance companies and the wealthiest Americans would enjoy massive financial windfalls and tax breaks, while the poorest, the elderly, the young, and the most vulnerable would risk financial ruin and death if they become ill. The backlash to the AHCA has been swift and decisive, with condemnation coming not only from Democratic and Progressive groups (as expected), but also from prominent medical associations:

  • The American Medical Association
  • American Nurses Association
  • American College of Physicians
  • National Nurses United
  • National Physicians Alliance
  • Association of American Physicians and Surgeons
  • American Academy of Pediatrics

From industry stakeholders with huge memberships:

  • The AARP
  • American Hospital Association
  • Federation of American Hospitals
  • America’s Essential Hospitals
  • Families USA

And even from well-known conservative groups and think tanks:

  • Heritage Action
  • Cato Institute
  • Americans for Prosperity
  • FreedomWorks
  • Tea Party Patriots
  • Club for Growth

From the moment it was unveiled, the AHCA has been (to put it in Trumpish terms) a total disaster. So why, after seven years of screaming and threatening and campaigning against the Affordable Care Act, why don’t Republicans have anything better to offer us than this hash of a bill? After reading the bill (summarized here) and considering the political climate and motivations of Republican leadership in Congress, it seems there are three scenarios that could explain this baffling fiasco: incompetence, inhumanity, or intentional failure. Let’s quickly run through each of these scenarios.

Incompetence: Republicans in Congress hated the Affordable Care Act because Barack Obama was President when it was passed, and they despised President Obama. Sure, there was some well-intentioned principled opposition to the expansion of entitlements in the ACA, but it was drowned out by disingenuous fear-mongering (remember “death panels?”) and pure uninformed rage. Instead of working on a set of fixes to improve the issues that the ACA does have, Republican politicians instead began feeding on the mindless anger to fuel their political campaigns – never thinking they might one day have to actually craft healthcare policy that affects 350 million people.

When faced with the daunting task of doing their jobs and fulfilling their promises, Republicans quickly realized they hadn’t a clue how to fix the healthcare system. Donald Trump was shocked to discover that the trillion-dollar healthcare industry used by every American citizen is actually pretty complex. Paul Ryan, a known “policy wonk” and “conservative intellectual,” discovered that you can’t apply Ayn Rand’s philosophy to the well-being of 350 million people and still make the numbers work. It quickly became clear that they never had a plan to offer a better alternative to the ACA, and aren’t up to the task of creating such an alternative. They simply cannot create a healthcare plan that insures more people, in a more affordable manner, while simultaneously protecting both businesses and the most vulnerable citizens. They aren’t capable, and that’s the very definition of incompetence. Unfortunately for us all, this may be the most likely explanation for the AHCA.

Inhumanity: There is a myth among conservatives that if a person is poor, they’re poor because of laziness or their own bad choices. In the vast majority of cases, this is simply not true, and to believe and repeat it is wrong. When this myth gets transformed into actual policy that affects the lives of millions of Americans, it is wrong to the point of cruelty.  People can be poor for a multitude of reasons beyond their control, not the least of which is unexpected medical expenses. A chronic illness or serious injury can quickly bankrupt a family, or worse, result in the inability to continue receiving care. People die as a result of not being able to afford health insurance. Let that sink in – because healthcare costs too much money, actual human beings suffer and die. Anyone with an ounce of respect for human life should find that unacceptable.

The AHCA seems based on a version of the “poor people make bad choices” myth. It takes away Medicaid from millions who rely on it, and refuses to consider income when calculating how much help the government will offer people to help them pay insurance premiums. Republicans in Congress seem to think it’ll all work out for the poors, if they just quit wasting their money on extravagant purchases like iPhones instead of going to the doctor – an idea that’s as out of touch with reality as it is condescending and insulting. But let’s say, only for the sake of argument, that the far right wing is correct – all poor people are lazy leeches who make bad choices, and their poverty and illness are solely due to their own irresponsibility. Well guess what – they still deserve health care. Why? Because they are human beings. If you want to address people’s work habits and lifestyle decisions, fine – do it in a way that doesn’t deny them the basic right to medical care for their illnesses and injuries. Don’t pretend that it’s for their own good, either – it’s quite clear who stands to benefit from the AHCA, and it isn’t the people who need it.

Intentional Failure: Several people have floated the idea that Republicans never intended the AHCA to succeed. The theory goes something like this: Republicans know that Obamacare has been growing in popularity (especially since many vocal opponents have realized the ACA is actually how they got their own insurance), and that it would be politically disastrous to kick 20+ million people off of their health insurance. So they wrote a half-hearted replacement that they knew would never make it through both houses of Congress, intending to watch it die and then blame their inability to address healthcare on the Democrats.

If intentional failure was really the plan, it’s backfiring badly. The American public is placing the blame for the AHCA squarely on Congressional Republicans, and their leader in the White House. Donald Trump reportedly doesn’t want the AHCA referred to as “TrumpCare,” but the name is out there and it’s sticking to him; Trump and Republicans own this mess they’ve created, and it’s hurting them. Somehow, in this topsy-turvy, upside-down administration and Congress, Donald Trump and the GOP have managed to fail so spectacularly that they are now failing at failing. It’s almost impressive in a way. It might even be funny, if people’s lives didn’t depend on it.

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