Republicans' healthcare reform efforts are taking them down a perilous path. In control of Congress and the White House, they plan to pass a bill with zero Democratic support that pretends to repeal Obamacare and falsely claims to introduce market disciplines.
President Trump on Tuesday told a small group of Republican senators that their bill was too "mean" and needed to be more generous. Republican senators are privately saying there aren't 50 votes to repeal Obamacare regulations that drive up premium costs.
This puts the party and president on course for disaster. If Obamacare's costly regulations are left in place, the bill cannot honestly be described as "repeal" or "reform."
Republicans look ready to rush a bill that was drafted in secret through the Senate using the budget reconciliation process and probably relying on Vice President Mike Pence's tie-breaking vote.
It won't do what's needed to reduce premiums because it will preserve Obamacare's regulations that outlaw cheaper plans. If it were less "mean" and "more generous," as Trump wants — he had no such criticisms of the bill when it passed the House — it also would not cut the deficit. Fewer people would have insurance coverage, and state insurance markets that Obamacare has destabilized will get no relief.
The main accomplishment would be to repeal Obamacare's tax hikes, but a more "generous" bill would delay those cuts to disguise their budgetary impact. Tack on subsidies for insurance companies, and voila: Republican healthcare reform!
Haphazard tinkering with a left-wing law that has failed and destabilized a vast and highly complex sector of the economy does not count as reform.
Republicans would not be repairing a crumbling bridge. They'd be buying that bridge. They'd be to blame when it collapsed.
There's still time to choose a better way, and Trump's call for more generosity could provide a good nudge if understood broadly.
During the primary campaign, he articulated his objections to GOP healthcare orthodoxy, saying: "Nobody is going to be dying in the streets with a President Trump." He was voicing the widely held moral sense that nobody should die because he can't afford an available surgery, and nobody should go poor because she had the bad luck to get breast cancer.
Trump and congressional conservatives could be generous with market reforms by doing what they promised to do, which is to repeal Obamacare. True reform would introduce competition, reduce costs, improve quality and make sure that fewer people are trapped or slip through the cracks.
What's needed is a robust, lightly regulated private market with a government backstop for those whose costs exceed their means. Democrats would object because this would actually repeal the dismal totem of Obamacare. But Democrats are already crying murder over a bill that leaves Obamacare broadly in place, so Republicans should pluck up the courage to do what actually works.