One of the fantasies peddled by the right-wing Rage Machine collided rather violently with itself this week and sent to the canvas the Republican plan to "repeal and replace" Obamacare, perhaps for the count. "President" Trump has tried to blame Democrats for the problems the plan has faced. The truth is that it has gone down in flames as a consequence of a fight within the GOP, as one wing of the Fantasy Faction battled it out with the other.
Turning to the Wall Street Journal, one sees a manifestation of this fight, an editorial crowing about how the awful GOP healthcare "reform" bill is actually great and pouring derision upon the other denizens of the Faction for not embracing it. With no sense of self-awareness, the pro- segment of the Fantasists are here dubbing the anti- segment "the Freedom-From-Reality Caucus." Entertaining, sure, but another painful indication of how badly political discourse on the right has entirely collapsed.
An outline of the basic problem: Republican hostility to Obamacare isn't based on any sort of realistic evaluation of that law or its effects. It's born, instead, of the persistent demonization of the law by the right-wing Rage Machine. Fox News and co. rage against it and blame it for every problem in American healthcare, though most of those problems long predated Obamacare and are, at best, only tangentially related to it. As a political matter, it's quite easy for Sean Hannity to rant and rave against Obamacare day after day. It's a lot more difficult for legislators to replace it. Over the course of eight years during which they've cast dozens of empty votes to repeal the law in full or in part, Republican legislators have made no serious effort to develop any real alternative to it. Obamacare was the Republican alternative. When Obama embraced it, every Republican fled from it solely because Obama adopted it and they feared any cooperation in further shaping it would be presented to their constituents by Rush Limbaugh as collaboration with the enemy. Now, having achieved domination of all three branches of government, they've finally been put in a position to deliver and they don't have anything to deliver. They have no plan. They've made no effort to develop any constituency for any alternative. The portion of their voters who listen to Lou Dobbs want them to repeal it. But that's all.
So the new congress came into session in January and the Republicans who lead it had to come up with something. Simply repealing the law and returning to the pre-Obamacare status quo, initially favored by many, wasn't a politically viable option; that would leave consumers entirely at the mercy of the insurance giants and bring back all the ever-escalating problems that led to Obamacare in the first place. Republican legislators rushed to cobble together some sort of "reform" plan. The result was an abysmal, half-assed effort that, thrown together in a matter of weeks, takes the already-awful Obamacare and makes it even worse. That "worse" is born out by every means of measurement. More to the point, the provisions of the bill have no substantial public support. The bill exists solely so Republican legislators can tell the audience for the Rage Machine that they repealed the awful thing that black guy did. That wouldn't help pols when they had to face their angry constituents, the people who would be entirely screwed over by the changes. The bill was a fantasy crafted by one wing of the Fantasy Faction ("President" Trump threw his weight behind it).
But while that wing was hoping to garner the approval of the Rage Machine via the bill, the other immediately recognized the practical political problem it represented. While Repub legislators may play the political game of blaming on Obamacare rising premiums, high deductibles, etc., the smarter ones realize these are problems rooted in the basic for-profit health insurance model. They have no interest in embracing single-payer healthcare, the one serious alternative that would do away with that model and its problems, nor would the Rage Machine allow them to do so even if they wanted, but if they vote for anything at all, they realized they'd then be held responsible by voters for the state of healthcare after that, including all of its problems. This wing of the Fantasy Faction, the "Freedom Caucus" Republicans who have been more responsible than any other elected officials for demonizing Obamacare and creating this situation, have now bailed on the "reform" plan, calling it "Obamacare Lite." For the reasons just outlined, they're probably not going to be getting behind any other reform effort either. Why should they? The ire directed at Obamacare by the Rage Machine--and by these legislators through the Machine--has proven a remarkably effective means of organizing their supporters. They want to keep Obamacare around as their whipping-boy.
Here's what lurks behind all of this: American healthcare is on an unsustainable course. It can't go on like this.
Here's a truism: It's impossible to effectively govern anything based on fantasy.
The Rage Machine, which is made up of nearly ever major rightist outlet in the U.S., grew out of--among other things--the fact that there exists so little public support for right-wing policies. The American rightist elite use it, in light of this, to drain most of the actual substance from politics, presenting political discourse as a simplistic, good-vs.-evil struggle of personalities, with, of course, themselves as the heroes. In their telling, a fact, as the concept has always been understood, doesn't exist. The "truth" is whatever the Machine says it is. Their followers are told to stop thinking and get behind the heroes of the tale. This has created the Fantasy Faction, those who have convinced themselves that the largely fictional political narratives they get from Bill O'Reilly and Michael Savage are reality and those who exploit this state of affairs for their own ends. It's one of this writer's most persistent themes over the years (in his political writing, at least).
When it comes to government, the Machine amounts to an unelected, unaccountable rightist elite that never have to deliver anything more substantial than wind but that are allowed to wag the dog. In this just-concluded healthcare drama, we've just had a "reform" effort be invented in order to play to a fantasy then be killed because continuing to play to the same fantasy was judged by some to be more important. Any concern for the public interest is just as entirely M.I.A. as reality itself.
 The rush was dictated in part by certain political realities--Republicans know they'll probably lose big in the 2018 midterms--and in part by the desire to translate the spoils from eviscerating Obamacare into a massive tax cut, which could, as a consequence of congressional rules, be presented as revenue-neutral and passed with a simple majority, rather than having to overcome a Democratic filibuster in the Senate.