As Senate health care debate proceeds, nation takes two steps back

The effort to repeal and replace the Affordable Care Act, aka Obamacare, has turned into a debacle of democracy, highlighting and exacerbating the worst features of contemporary politics.

The vote in the Senate to begin debate passed by the narrowest of margins. But, that is enough to prime the pump for a party hell bent on repealing the ACA. On top of that, the drama of Sen. John McCain, recently diagnosed with brain cancer, returning to Washington to back the repeal effort, has to help Republican leaders in their push to get this dreadful bill across the finish line. Last week, when it looked like this bill was going nowhere, I warned against complacency. Efforts to defend the health care of our fellow citizens must be redoubled in the days ahead as the Senate seeks final passage of this horrible law.

Last week, President Donald Trump brought all the Republican senators to the White House and, with the cameras rolling, he delivered a not very subtle threat to Sen. Dean Heller of Nevada. "Look, he wants to remain a senator, doesn't he?" asked the president, looking at Heller out of the corner of his eye. The senator, who was seated on the president's immediate right, squirmed in his seat. The video is painful to watch.

Monday, Trump was at it again. Speaking from the Blue Room, he first castigated Senate Republicans. "Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare, which is what it is," the president said, speaking so forcefully the kids behind him looked terrified.

Unsurprisingly, the president did not admit to his role in creating this nightmare. Last week, the Daily Beast reported that the Trump administration had devoted public funds to undermine the Affordable Care Act. Money targeted to help people enroll in insurance programs was actually used to undermine insurance markets. As well, the uncertainty caused by the prospect of repeal has thrown a huge question mark into markets, and markets don't like question marks, especially insurance markets.

Then the president took aim at the Democrats, blaming them with obstruction. Well, yes, obstruction is what one does when faced with a proposal that you think would be harmful. And a plan that is estimated to kick between 23 and 32 million people off the health insurance rolls is not hard to view as harmful.

"[The Democrats] run out. They say, 'Death, death, death.' Well, Obamacare is death," Trump said. "That's the one that's death." I will grant that some people, maybe even too many people, have seen their premiums go up in recent years, and that the ACA needs some adjusting, but death? Of course, this is from the man who is still questioning every intelligence agency of the government he leads about Russian meddling in the election.

Trump is a phenomenon unto himself, to be sure. What is Sen. Mitch McConnell's excuse? Monday, he took to the Senate floor and said, "I know many have ideas on how to improve health care. The only way we'll have an opportunity to consider ideas is if senators are allowed to offer and debate them. That means voting to begin the open amendment process."

Actually, there is this thing called "regular order" by which legislation is supposed to be advanced. Committees hold hearings and mark up the legislation. They debate it, add amendments and such, and then vote on whether to send it to the full Senate for consideration. The bill voted on yesterday was drafted in secret, with no committee hearings whatsoever, and sent directly to the full Senate. Opening debate on this flawed proposal is not the "only way" forward as McConnell claims.

Is it asking too much that the chamber that styles itself "the greatest deliberative body in the world" actually deliberate before taking a step of such consequence for millions of Americans?

Shockingly, it was not only the departure from regular order that offended the idea that the Senate is a deliberative body. On the eve of the vote, it was not even clear what bill would be presented to the Senate. One almost felt sympathy for the Republicans' whips. How do you whip a bill when you are not even sure which bill you are whipping? Just writing that sentence feels strange, like diagramming a tongue twister.

The Catholic faith is silent on parliamentary procedures. But, the Catholic faith has long taught that access to health care is a basic human right. On Monday, a letter signed by more than 7,000 religious women was delivered to members of the Senate. The letter, which was drafted and circulated by the Catholic social justice lobby NETWORK, read in part, "As Pope Francis teaches, 'health is not a consumer good, but a universal right, so access to health services cannot be a privilege.' Responding to this integral part of our faith, many of our religious congregations founded hospitals and hospital systems in the United States. Other congregations sponsor clinics and various services for people on the economic margins. The passage of this bill would cause far more suffering than we could possibly attend to through charity. For this reason we are speaking out."

In the days and weeks ahead, Catholics must stand with the sisters and join them in speaking out. Millions of our fellow citizens, most of them among the working poor, are going to lose their access to basic health care if this bill ever makes it to the president's desk. Future efforts to enact universal health coverage will not be undertaken in our lifetime. It is shocking that a major political party would be so indifferent to the sufferings of so many in order to achieve tax cuts for so few, but that is where the politics of fear and scarcity have brought us. Our culture is at a tipping point and it looks like it is about to tip away from human decency and dignity. And our democracy has suffered a horrible blow.

And so the bill advances, but the nation takes two steps back, one step back on health care and one step back on the health of our democracy.

[Michael Sean Winters covers the nexus of religion and politics for NCR.]​

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