It should be axiomatic among Republicans that Obamacare must be repealed and replaced during the current Congress. The last opportunity to do so appears to be the Graham-Cassidy bill. That being so, it must pass, and it must be improved before it passes. Specifically, the bill’s experiments in actual health insurance markets, need to be made more robust.
It is only by passing a repeal and replace bill that Republican politicians can avoid breaking the cardinal promise they have made to voters for the past four election cycles. It was the central rallying cry of John Boehner’s successful retaking of the House in 2010. Running Mitt Romney, author of Obamacare’s state-level prototype in 2012, proved a Republican mistake that helped save Obama. Campaigning against Obamacare helped Republicans take the Senate in 2014. Repealing Obamacare was the only policy agreed upon by all 17 GOP presidential candidates in the 2016 campaign.
If Republicans, while in control of government, do not replace Obamacare after promising so many times over, there is no reason for voters to trust another GOP legislative promise.
That’s the political reason Republicans must reform healthcare. The more important reason is that it is better to have good government and wise policies than to have bad government and foolish, damaging policy. Obamacare is a rickety and ill-made contraption — not to mention dishonest, debilitating, and corrupting — and it is bound to collapse. And the collapse is not likely to lead to an agreement that government meddling with health insurance has proved a baneful experience not to be repeated. It is just as likely, perhaps more likely, to lead to yet further excesses, specifically the introduction of a single government insurer — the “single-payer” plan that Democrats are rallying around today.
With Graham-Cassidy, congressional Republicans may be looking at the last exit to sensible, market-based insurance off the highway to hellish socialized medicine.
But just because Obamacare leads to socialized health insurance, it doesn’t necessarily follow that any replacement will allow us to avoid it. A bad GOP replacement is likely to keep America on the path to socialism. It might even get us to that unwanted destination even sooner.
Obamacare, at its core, was about stapling redistribution and a government safety net to the private insurance market. This means markets can’t work because proper pricing is unlawful, which means that what is referred to as insurance is really no such thing. The system, built on structural and rhetorical falsehood, will crumble as a result, and will, in doing so, bring down both the ersatz insurance market and the jury-rigged safety net.
Real reform needs to make room for markets to function. Obamacare’s regulations prevent this. Ideally, Congress should repeal its regulations, but we are quite obviously not living in the conservative’s ideal political environment.
This is where the virtue of federalism shines. A true replacement will devolve power to the states. Graham-Cassidy has the rudiments of an effective federalism. States have more leeway to build a safety net as they think best, and to introduce efficiencies into Medicaid. But the bill doesn’t grant states enough leeway on regulation. For one thing, it ties regulatory waivers to the receipt of federal funds, and it seems to give the federal Department of Health and Human Services the ability to choke off all regulatory freedom for states. This would make the waivers impotent the next time a Democrat wins the White House, making this faux-federalism.
The urgency of replacing Obamacare cannot be understated. Give competitive federalism a chance; it’s what the country’s founders had in mind. It’s urgent that senators improve this bill, then pass it.
