There has been high drama about the Trumpcare (aka ACHA) health bill introduced to replace Obamacare and whether it will pass both houses of Congress despite Republicans having majorities in both. Yesterday’s deadline for a vote, set for the stupid symbolic reason that it was the seventh anniversary of Obamacare’s passage, came and went without a vote and another deadline has been set for today.

I have not followed the vote counting closely because I am pretty sure that something will pass since Republicans have placed so much of their credibility on this bill. I strongly suspect that Donald Trump does not know what’s in the bill and doesn’t even care. For him, passing the bill is important because it can be hailed as a ‘win’ for him.The only issue is the extent to which the new health care bill will hurt the poor: very badly as desired by the party’s ‘moderates’ (who are really extremists) or extremely badly as desired by the party’s ‘extremists’ (who are pretty much unhinged). Kevin Drum lists the ten EHBs (Essential Health Benefits) that all insurance companies must currently provide as part of coverage and the intra-Republican fight is about how many of them are to be eliminated.

1. Doctor visits
2. Emergency room visits
3. Hospital visits
4. Prescription drugs
5. Pediatric care
6. Lab services
7. Preventive care
8. Maternity care
9. Mental health care
10. Rehabilitation services

Drum predicts the consequences of eliminating these as requirements and making them optional riders to policies.

Even if the current version of AHCA doesn't cause a death spiral, it sure would if EHBs got repealed. Insurers would assume that anyone who asks for a policy that covers one of these (former) EHBs is pretty sure they're going to need it. Naturally they'd price their policies accordingly: Worthless policies would get really cheap, but comprehensive policies would get astronomically expensive. Virtually no one would be able to afford them.

All the EHBs are things that a normal human being would consider to be essential health services that everyone should have access too. But for Republicans, these seem to be considered luxuries that poor people should be willing to pay out-of-pocket for, even maternity and pediatric care. So much for family values.

The fact that Republicans are devoted to enriching the already wealthy is not news. It is also not news that in their efforts to do so, the poor will take some hits. But it might have been thought that the harm to the poor was an incidental byproduct of the transference of wealth to the rich, collateral damage if you wish to use the language developed to sanitize war crimes that kill the innocent.

But there seems to be more at play than this. There seems to be something almost joyful in the way they seek to hurt the poor. Chauncey DeVega tries to understand the reasons why in ideological and sociological terms.

Like his idol Ayn Rand (who argued against the very idea of government and the commons yet received social security and Medicare). Paul Ryan has combined meanness, cruelty and callousness towards the weak and the vulnerable with gross and unapologetic hypocrisy.
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It is normal to feel aghast at and disgusted by the Republican Party’s war on the poor. The more challenging and perhaps even more disturbing task is to ask why today’s conservatives feel such antipathy, disregard and hostility towards poor and other vulnerable Americans. Certainly greed and a slavish devotion to a revanchist right-wing ideology are part of the answer. But they may not be sufficient
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Conservatives are more likely than liberals or progressives to believe in what is known as the “just world fallacy,” where people who suffer misfortune are viewed as somehow deserving their fates.
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Conservatives are capable of being empathetic. However, conservatives focus those feelings on their in-group such as immediate family and community.
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Unfortunately, the Republican war on the poor is but one sign of the deep moral rot at the heart of American society. This crisis extends well beyond the election of Donald Trump and the cruelty both promised and so far enacted by his cadre and the Republican Party. If a society is judged by how it treats the most vulnerable and weak, America is a country in decline, a country whose citizens should be ashamed of their leaders — and, in some cases, ashamed of themselves.

I too used to think that this callousness towards the poor was ideologically based on a strong devotion to applying free market principles in all walks of life at whatever short-term cost to individuals, in the belief that there will be long term benefits to everyone.

But now I feel I was mistaken. The Republican control of the presidency and both houses of Congress has lifted that mask and revealed something truly ugly, that there seems to be something pathological in their desire to hurt the poor, a vindictive glee at the thought of punishing those whom they think are parasites on society, when it is the wealthy who are the true parasites.