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Saturday, March 25, 2017
Obamacare Replacement: Waiting for Godzilla
Whether you are cheering the principled holdout for a better bill or lamenting the circular firing squad led by the Freedom Caucus, the fact is that the first attempt to put a bill through the House to repeal and replace ObamaCare has landed short. Something of a civil war has broken out among various camps of The Party That Finally Has to Govern. Conservative critics called the American Health Care Act "RyanCare" when they were polite, "Obamacare Lite", "Obamacare 2.0" and other names not fit to print when they are feeling less so. Why the hysteria? With Republicans firmly in charge for at least two years, there should be plenty of opportunity to amend, reinforce, and extend whatever reforms we lead with. Why not use this bill as a beachhead and continue from there? Why let the Perfect be the enemy of the Good?
Taking the bill's proponents' words at face value, the AHCA is (was) to be understood as the opening salvo of a three-part strategy which matches each of the various desired policy goals with the procedural processes under which each is most likely to succeed. Thus, as David Catron of the American Spectator put it, " AHCA will use the reconciliation process to kill Obamacare's mandates and taxes,  HHS Secretary Price will exercise his authority to eliminate its morass of regulations, and  the few remaining changes are going to be passed via the normal legislative process." Fair enough; who can argue with having the Secretary of the Department of Health and Human Services do what his position (and, ironically, ObamaCare itself) empowers him to do by fiat rather than try to push a boulder up Senate Hill?
But a lot of the AHCA's proponents' (including Trump's) arguments had a "take-it-or-leave-it" tone, or worse, "Last Chance!" (before the coming 2018 midterm massacre). Why? If we drink Coke today, can we not drink Pepsi tomorrow? Did this bill, like the one it purported to replace, exclude all other options and follow-ons? Was it comprehensive, all-or-nothing, admitting of no further alteration lest its entire superstructure collapse? Does this bill represent our tacit acceptance of the proposition that the solution to one massive social engineering scheme is another radioactive sea monster that we must commission to stomp us without recourse?
The quoted phrase above "the few remaining changes" has a ring either of naïveté or of smug conceit about it: "do these three things and we're done, don't bother us anymore". Apparently not enough conservative members bought that line or worse, suspected that if they went along with the bill as written that it would restrict rather than expand options for passing additional reforms in the future. Smelling a rat trap, they "voted" to compel a restart.
The great failing of government solutions as opposed to market ones is that the former are categorical and one-size-fits-all. Under freedom, I may go to the supermarket and pick up the six-pack of beer and quart of milk that I want today, and some different mix of items tomorrow, answerable to no one except myself and my god (and my wife) for my choices; the equivalent government program would mandate that everyone in the checkout line fill their baskets with the same pound of (locally grown biodynamic non-GMO) broccoli, dozen (cage-free) eggs, pint of (extra virgin) olive oil, loaf of (gluten-free) bread and two dozen other enumerated items, whether we wanted that basket or not. In contrast, the great advantage and opportunity of free-market reforms over social engineering schemes is that each policy is a net positive in and of itself that does not have to be compensated for or offset somewhere else in a tangled web of dependencies.
Which is why, if we are true to our conservative, free-market, limited-government principles, we shouldn't have to get too exercised about the bill to replace Obamacare and instead simply proceed to propose, debate and vote up or down in separate, incremental bills all of the specific policies we believe should be implemented. Is competition across state lines without interference in the civil rights of citizens by state insurance commissars a good thing, or isn't it? That does not depend upon whether or not the FDA should fast-track approval of certain experimental therapies for desperately-ill patients. Those two do not need to be, indeed they do not really belong, together in the same bill. Likewise with health savings accounts/flexible spending accounts (HSAs/FSAs) and tort/malpractice reform. Both would be improvements, but the success of one is not in a suicide pact with the other. Tax and red-tape relief for physicians who offer services pro bono to the poor, and the freedom of any association of citizens from trade syndicates to bird watchers to create their own risk pools for mutual insurance purposes, could get proposed, debated and voted upon in a week each. The inevitable negotiations and horse-trading could be expressed, instead of by what's in and what's out, by the ordering and prioritization of the succession of bills.
Lists of these targeted policy proposals are not hard to find. Daniel Horowitz has a list. Sally Pipes has a list. I have a list. Even the American Health Care act itself in its evolving incarnations is a list of sorts which may be broken up if it can't be swallowed whole. And it's not like we have to take Horowitz's or Pipes' list and leave mine; the lists overlap and agree in the main, for a simple reason: they are all based on sound free-market economic principles rather than the progressive Marxist ethnic gender class grievance theory upon which ObamaCare rests.
So it ain't rocket science or brain surgery. It may, however, require a (slight!) modification in how things get done in Washington. Exploding "business as usual" is what the American people unambiguously demanded in the 2016 election, and Trump should persist in demanding a new paradigm: One targeted, specific, free-market reform per short bill, in rapid succession and yes, each one channeled through the process where it has the greatest chance of success.
One of the strongest arguments pro the AHCA may be one pointed out by the Wall Street Journal editorial of March 22: "the revised bill now accelerates the repeal of most Obamacare taxes to this year instead of waiting until 2018. This... will make it less likely that Americans hold off on investment decisions until next year to get the lower tax rate." If you understand that ObamaCare is not about medical care per se but about money, financial engineering, economic growth and the balance of power between the public and private sectors, then that is, in a word, huge. So pull that out, put it into its own bill and shepherd it across the finish line pronto.
The Freedom Caucus and its allies that led the conservative opposition to the bill are outnumbered by some estimates at five to one, so there won't be multiple opportunities to play the same card. The next bill that comes up, if it is a net positive that does not close the door on further free-market reforms, should be supported by all who are sincere in their opposition to the fundamental, socialist transformation of America.
We could start with the saddest casualty of the defeat of the AHCA: the repeal of the Tanning Tax.