The healthcare bill before the Senate today is not a full repeal of Obamacare. It is less than Republicans for seven years led voters to expect. But the perfect should not be the enemy of the good in politics, which is, notoriously, the art of the possible.
The question before Republican senators and representatives instead is: Is it better than Obamacare?
The bill is so new, insurance markets are so complex; federalism so messy, media accounts so biased, and the process so rushed, that it is difficult to pronounce definitively on the issue.
What the bill needs to do is get America off its current path toward socialized healthcare and to create space for markets to work their magic.
This makes the case for incrementalism and demands that Republicans practice it wisely.
Some conservatives reject Graham-Cassidy out of hand because it isn’t a repeal of Obamacare, many regulations of which will stay in place. The bill doesn’t eliminate Obamacare’s new federal spending on healthcare, but instead trims it and redirects it. Some of Obamacare’s tax hikes also survive.
All this is regrettable, but everything in politics involves compromise. If Republicans insist that their choice is either total repeal or nothing, they will get nothing.
Similarly, if conservatives insist on a bill that is a free-enterprise ideal, they will get nothing. The Left and Democrats provide a good example here. They practice incrementalism. They want “single-payer healthcare” (a euphemism that omits that the single payer, and thus the sole decider, will be the federal government), but they take what they can get when they can get it. Obamacare itself was an incremental move, a conscious (if dishonest) step toward a socialist system of providing healthcare. But, to America’s great regret, Obamacare shows how effective incrementalism can be. There it is on the statute book, a great, nearly immovable impediment to freedom and economic growth, and it is the launching pad for a government takeover. Its authors knew this, and they accepted that the glass was half full, rather than complaining that the glass was half empty and walking away to sulk. It would help its author, Obama, get to where he wanted America to be.
In this spirit, Republicans need to be ready to reform as much of healthcare as they can, when they can. Passing a bill that leaves some of Obamacare’s regulations, taxes, and spending in place isn’t morally the same as creating those regulations, taxes, and spending. If the bill moves health insurance in the right direction, Republicans should pass it.
But they should also be wary. Not every bill that chips away at Obamacare will be progress. This is not because Obamacare does not deserve to be demolished; it most assuredly does. But not every reform of it will make socialized medicine less likely. Not every cut in taxes, nod towards deregulation, or reduction in spending will help. Incrementalism isn’t merely about taking steps in the direction of your goal, because some paths are dead-ends or lead to pitfalls. But prudent incrementalism not only moves in the right direction, but also makes the later incremental gains more feasible.
Republicans cannot afford a “reform” package that kills some regulations and cuts some spending but leaves the individual market as unstable or more unstable than Obamacare has.
Federalism is the key. A good reform will give states the flexibility to deregulate aggressively to separate the marketplace from the safety net. The bill’s sponsors say their bill does so. Some knowledgeable conservatives argue, conversely, that the bill gives too much power to the Health and Human Services Department, so that the next Democratic president could easily rip this freedom away from the states.
Senate committees will mark this bill up. It will change shape. We will learn more about it. As Republicans shape this bill, they must not simply strive to pass something, anything, for the sake of a “win.” They must aim for a reform that lasts, and to the extent that it does not last makes rfurther rook for market forces. It’s what the nation has craved, nay demanded, since the inception of the grotesque system under which we now toil. We ask those senators whose personal resentments or electoral calculations are now clouding their judgment, to live up to their oft-repeated incantation of “public service,” and do what really moves us toward what will work for the good of the country.
