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According to the Congressional Budget Office, the Senate GOP’s health care bill — officially known as the Better Care Reconciliation Act — will lead to 22 million fewer people with health insurance and plans with such high deductibles that low-income people won’t be able to afford them. On the bright side? Massive tax cuts for the rich. It’s not a widely popular vision — the bill is struggling to attract Republican support, and is polling between 12 and 17 percent. But it does have defenders. Chief among them is Avik Roy, a past guest on this podcast and the co-founder of the Foundation for Research on Equal Opportunity. The bill’s passage, Roy said, would be "the greatest policy achievement by a GOP Congress in my lifetime.” I am, to say the least, not a fan of this legislation. So I asked Roy to return to the podcast to discuss it. I wanted to hear the best possible case for the bill. In this conversation, we discuss the Better Care Reconciliation Act, but also the broader health care philosophies that fracture the right. We talk about Roy’s disagreements with the CBO’s methodology, as well as the many, many ways he thinks the Senate bill needs to improve. We talk about the ways the GOP has moved left on health care policy without coming to a consensus about what the policy is meant to accomplish. We talk about Medicaid, about welfare reform, and about how policymakers should think about the needy who are hard to help. We talk about the many ways the American health care system subsidizes the rich, and the way that money could be better used. Roy, I would say, is a lot more enthusiastic about the Senate bill in theory than in practice. After this discussion, I better understood why he sees the bill as a victory for Republicans who want their party to embrace universal health care, but I left thinking he was underrating the dangers of a party that isn’t united behind that vision implementing legislation like this. We discuss that, too. If you want to understand the GOP’s internal dynamics on health care, listen to this conversation. I cover this stuff for a living, and I learned a lot.

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