Remember the South Park Underpants Gomes? Phase one, steal all the underpants. Phase three, profit! The problem is that nobody knows what phase two is supposed to be, or how collecting all the underpants leads to profit. They just have absolute faith it will work.
The Republican Party seems to have an Underpants Gnome problem. There are several news stories out today saying that congressional Republicans are panicking about rising health care and other costs, and they don’t know what to do about them. Politico:
Republicans want to put the economy at the center of their midterm message as they seek to protect their majorities in Congress. But as cost-of-living concerns mount across the political spectrum, the GOP is struggling to act decisively to address them.
Already top Republicans acknowledge they haven’t done enough to sell the “one big, beautiful bill,” the party-line centerpiece of their economic agenda they enacted over the summer. Now internal divisions and the need for bipartisan support in the Senate are threatening any attempt to follow up on it.
For Republicans, cutting taxes on corporations and the wealthy is always phase one that will take us to phase three, someday, although payoff day never seems to arrive. The Big Ugly Bill was kind of an enhanced phase one, in that it is cutting a lot of safety net benefits, notably health care subsidies, along with taxes on the rich. It was blazingly obvious to anyone Not a Republican that this was going to price millions of Americans out of their health insurance and possibly set off a wave of insurance hikes for everybody. It was also predicted that several other provisions such as cuts to green power tax credits would push up energy prices, which is already happening. All that, combined with Trump’s nutso tariffs and deportation of the immigrant labor pools is sending the cost of living up, up, up.
Lots of people saw this coming. What did Republicans expect?
The GOP is struggling to coalesce behind a health care plan that would prevent Obamacare premium hikes set to kick in next month and efforts to rein in President Donald Trump’s tariffs have run aground in the House. Meanwhile, the administration’s proposal to distribute $2,000 rebate checks has gotten a lukewarm response on Capitol Hill and the fate of other smaller bills to address things like housing prices and student debt have sparked intraparty sparring.
Republicans are always coming up with little band aids that they think will cure the problem. This morning I read that Josh Hawley has proposed making all out-of-pocket health care expenses tax deductible. So does that mean that if Jim loses his insurance and has to pay $100,000 in 2026 for his cancer treatments, the IRS will refund the $100,000 in 2027? And let’s say Jim makes the annual median salary for the U.S., which is $61,984. And in 2026 he doesn’t have $100,000. Will his health care providers treat him on the promise that he’ll pay them when he gets his refund?
Somehow, I don’t think that’s what Hawley means.
And that takes us to the bigger issue, which is that Republicans don’t ever seem to understand how anything works. They cannot ever come up with a usable health care policy because the only way they seem to be able to view the issue is through the prism of reducing the hit to the federal budget. That means all of their solutions come down to dumping more of the cost onto patients and health care providers. And ultimately the Republican insistence that health care must be paid for by a private, for-profit insurance system and not taxes has left us with a Byzantine monstrosity of a patched-together system that is far and away the most expensive in the world but fails to actually deliver health care to too many people. The administrative costs alone are staggering.
And it can drive all crazy maneuvering through the maze of programs and insurance plans that too often still leave patients with medical debt. Sorry to vent, but New York likes everyone on Medicaid to be in some kind of “Medicaid Advantage” plan administered by an insurance company. That means I’m in a dual eligible Medicare-Medicaid D-SNP plan, and the plan I was in was screwing up my bills. So I spent hours this year researching one to move to, and since they’re all HMOs I had to find one in which all of my providers are in network. The companies don’t all let you search their physician database before you join, so you have to call or do those endless online chats to check them out. It’s insane. And the whole time I’m thinking wouldn’t it be great if there were just ONE BLEEPING SYSTEM AND EVERYONE IS IN IT? Anyway, I’m in a new plan now for 2026. Wish me luck.
Even though of us who support the Affordable Care Act usually acknowledge it fell short of what we really wanted, but it was at least a step in the right direction. The thing that needs doing is to step back from all the programs, public and private, and just consider the most cost-effective way to provide necessary medical care to Americans in all income brackets. Going by what works in other countries, that would be a system in which the private insurance companies are kicked aside in favor of a taxpayer supported system. And in most such countries the system pays for health care for citizens and legal residents. Other people may have to either pay into the system or expect to get help only for serious emergencies. For those who would rather die from a ruptured appendix because they couldn’t afford surgery than to have a single penny spent on illegal aliens, — we really need massive immigration reform also. But that’s another rant.
The point is, though, that it’s obvious a unified, taxpayer-supported system would be less of a financial burden to both the government and to citizens. And I doubt even a bad system would be any worse than what we’ve got now. Most nations with a national health care system of some sort get better results than we are getting. Yes, you can get first-rate health care in the U.S. if you have lots of money and/or a really great company benefit plan. But everyone else falls through too many cracks.
The only industrialized country other than the U.S. that expects health care to be paid by private insurance is Switzerland. The Swiss system is basically Obamacare on Steroids. Everybody is mandated to buy insurance, and the insurance is regulated up the wazoo to keep it honest. It works for the Swiss, but I understand the Swiss pay more as a percentage of GDP in health care than other European countries..
Still, the Republicans are frantic to stop a health insurance apocalypse that could cost them lots of votes in next year’s midterms. What are they going to do? Let’s look at Cassidy projects optimism on winning bipartisan support for his health care plan
Sen. Bill Cassidy (R-La.) said he planned to present Republican leadership with his health care plan as soon as Sunday night, predicting that the divisive proposal to put money directly in Americans’ health savings accounts could clear the 60-vote threshold needed to pass in the Senate.
“We’re working to deliver to Leader Thune and Speaker Johnson a plan, which I think could get 60 votes, which gives the American people the power, and they can choose a lower premium and an HSA,” he said in an interview on “Fox News Sunday” with host Shannon Bream. “We’re working on that. And I’ll give them a piece of paper probably by e-mail tonight.”



