It isn’t as cool or as famous as the Coke vs. Pepsi battle, but the battle lines have been drawn in the healthcare debate.
There are three factions: the doers, the fundraisers, and the curmudgeons. On one side, there is a coalition working to reform the healthcare market by repealing the majority of Obamacare and moving healthcare policy back toward free-market reform. On the other side are organizations that are either happy with the status quo or don’t care about reforming the system because reform means they won’t raise as much money.
Let me start off by making a clear statement: I am a doer, and I support the reform bill from House Republicans, the American Health Care Act.
I have worked in and around healthcare policy for more than a decade. I helped the Republicans create the Medicaid block-grant bill that they used as a major part of their platform for several years. Recently, I helped the Goodman Institute, Sen. Bill Cassidy, R-La., and House Rules Committee Chair Pete Sessions, R-Texas, create the first reform bill introduced in both the House and the Senate since Obamacare. I was one of three founders of the Free Market Medical Association, and I sit on the advisory board of a startup healthcare company that helps connect patients with free-market providers: my goal is a more competitive healthcare market, because competition means lower costs and better quality.
The AHCA helps create that more competitive market. It does so by gutting as much of Obamacare as is likely possible under the rules of reconciliation (more on that later), it provides a flexible tax credit, reforms the unsustainable Medicaid expansion, and lowers the overall tax burden by more than $1 trillion dollars. There’s more in the bill, but in general it’s about reducing government intervention and giving patients more power.
(Shocking, I know.)
However, the bill isn’t perfect. I would like the tax credit to be extended to people at work, along with ending the employer tax exclusion. I would like patients to be empowered to spend HSA funds on insurance premiums and health-sharing ministries. I would like to see payments to hospitals lowered to the same level paid to surgery centers. In general, though, I would like for the government to remove itself from healthcare because government distorts markets, drives up the cost, reduces access, and reduces quality.
That doesn’t mean that doing nothing is better, unless you are member of the other two factions in this battle.
The fundraisers are threatening to stop the AHCA, but they don’t really have a leg to stand on. They merely want to financially benefit from opposition. One of the groups in particular is so well-to-do that they own almost a whole city block of Washington, D.C., just a few steps away from the Senate. Since the walk over to the House side is much too far, they also have an annex on that side of Capitol Hill.
However, since the passage of Obamacare they haven’t convinced any members to create a bill that would be their answer. Nope, the fundraisers have done nothing but object and obstruct – all while their hand is out asking for more resources for the privilege of objecting and obstructing.
The curmudgeons, like curmudgeons tend to be, aren’t as funny or entertaining as the fundraisers. The curmudgeons refuse to support bills that they didn’t create. If Speaker of the House Paul Ryan didn’t put a comma in the right place, they would object. (Punctuation is important, people, just look at the Oxford Comma debate in Maine for proof.)
The curmudgeons that object to the current bill do so for several reasons, but mainly because they don’t think that the AHCA doesn’t go far enough. In this, they are right, but they also aren’t paying attention to the parliamentary rules that any successful bill will have to navigate.
Following the rules of reconciliation is no trivial matter. Under them, a budget reconciliation bill is considered privileged, meaning that a bill can move forward and pass with only 51 votes instead of 60 that it would take under regular order.
So, maybe comparing the healthcare fight ahead to Coke vs. Pepsi wasn’t the right comparison at all. A better comparison would the cod liver oil vs. snake oil vs. poison. One tastes bad but can help, one won’t do anything, and the last could actually hurt you.
The question is, what will members of Congress do? I personally hope that they choose to lead, they choose to make a difference, and that they choose to do something rather than maintain the status quo. People’s lives are at risk.
Charles Sauer (@CharlesSauer) is a contributer to the Washington Examiner’s Beltway Confidential blog. He is president of the Market Institute and previously worked on Capitol Hill, for a governor and for an academic think tank.
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