When Republicans fail to advance a limited government agenda when they have power, it does not merely entrench the status quo — it paves the road for liberals to fulfill their expansionist dreams when they’re in charge.
There is no better example of this than on healthcare policy. For decades, Republican inaction and acquiesce has allowed liberals to make uneven yet substantial progress toward their ultimate goal of imposing government-run healthcare on the United States. This time, Republican dithering may just enable Democrats to reach that promised land.
In 1994, Republicans cheered after defeating President Clinton’s push for national healthcare.They moved on to other issues, and avoided comprehensive free market healthcare reform when they had unified control of government during the second Bush administration. Democrats regrouped, learned from their mistakes, and honed their policies and messaging as they waited for their next opportunity. When given the chance, they passed Obamacare.
Republicans could have spent their time in the Obama era wilderness doing the hard work of building consensus around an alternative vision for healthcare when the stakes were low. Instead, they squandered this opportunity by focusing their efforts on scoring daily messaging victories. In the short-term, the strategy seemed to pay off politically, as Republicans regained unified control of government. But when it comes to achieving longer-term policy victories, the strategy has proven a dismal failure.
When Republicans took over in 2017, they had to start largely from scratch to gain support for plans to repeal and replace Obamacare. Though healthcare is among the most complicated domestic issues, Republicans wanted to race through the issue as quickly as possible so they could get on with tax cuts. Despite seven years of promises to repeal Obamacare, they came up largely empty handed. (Repealing the individual mandate penalties is not the same as advancing a broad free market healthcare vision.)
Republicans seem to have resigned themselves to moving on. From a purely technical standpoint, it remains highly unlikely that Republicans will even pass a budget this year, let alone one that would include the reconciliation instructions that would be necessary to pass any sort of healthcare bill with a simple majority in the Senate. Of course, even if they had the procedural tool to pass a bill with a simple majority, they are no closer to getting 50 Republicans to agree on a plan than they were last fall. And if they don’t address the issue this year, they aren’t going to be able to in 2019, when even under the best case scenario they’d have a much narrower majority in the House.
It would be bad enough if Republican stumbles merely preserved an Obamacare status quo with rising premiums and dwindling choices. But by failing to deliver on an alternative, Republicans are providing the space that Democrats need to plot their next big expansion. And liberals have been using that space to develop competing plans all with the goal of completing the job that Obamacare started.
The latest effort, introduced by Sens. Jeff Merkley, D-Ore. and Chris Murphy, D-Conn, would dramatically expand Obamacare and Medicare as part of an effort to transition the system toward a single-payer, or government-run, program. The plan, which has 10 Democratic co-sponsors, is a souped up version of the public option plan that liberals originally pushed for in Obamacare, which would have had a government-run plan offered along private plans on the program’s government-run exchanges.
Under the newly-proposed bill, individuals would be allowed to buy Medicare coverage on Obamacare’s exchanges, whether they are buying insurance on their own or they are offered it through their employers. Under current law, Medicare availability is limited to senior citizens, and Obamacare excludes the more than 150 million Americans who obtain insurance through their employers. Over time, this could easily morph into a European-style single-payer system.
What’s more, not only do the senators propose to make Medicare, whose costs are crippling to the nation’s long-term debt prospects, available to a wider number of people, but it would also aim to make the benefits more generous. The senators propose capping out-of-pocket costs in Medicare, and also making Obamacare’s subsidies more generous and more widely available. Under the current system, Obamacare’s subsidies aren’t available to individuals earning over $48,600 — but this bill would make them available to singles earning nearly $73,000 — or about $150,000 for a family of four.
The proposal leaves out many key details. For instance, the senators do not include an estimate of how much the bill costs or how they would propose to pay for it. It is also open to many criticisms and will struggle with inevitable tradeoffs. If the plan aims to keep costs down by paying doctors and hospitals the same lower rates as traditional Medicare, it will lead to massive losses for providers that will make it harder for Americans to access care. If payment rates are higher, costs can easily spiral out of control. Set premiums too high, and not as many people can be covered. Set them too low, and there will have to be an additional financing mechanism, thus making it impossible to argue that the plan can pay for itself. How would this affect employer coverage, which more than half of the country is dependent on? How can insurers being asked to participate be confident that the government, which sets the rules on which exchanges operate, won’t rig the game in favor of the government-run plan, thus driving insurers out of business?
These questions and more would no doubt have to be litigated. But for the purposes of looking at the broad trends in healthcare policy, it’s significant to note that Democrats are not in defensive mode. They aren’t, for instance, focusing on ways to scale back Obamacare or ease off on its regulations. With this proposal and others, they are focusing on ways to make its insurance more comprehensive and widely available and less dependent on the private insurance market.
At the same time, they are clearly thinking about the messaging. Few people out of the healthcare policy or political world know what a “public option” is, but Medicare is widely known and popular. It’s no surprise that Democrats are consistently trying to brand their plans for a socialized system as simply Medicare. The formal title of the bill is the “Choose Medicare Act” and the new option is described as Medicare Part E. Socialist Sen. Bernie Sanders, I-Vt., has also similarly branded his own, even more extravagant single-payer plan as “Medicare for All.”
From now on, when premiums inevitably skyrocket and Americans encounter problems finding insurance, it will no longer work in Republicans favor, as it did when they were out of power and they could simply point fingers at Obamacare. Republicans will be blamed for the ills of the healthcare system, because for years they claimed they could deliver an alternative, and they didn’t. Democrats will be all too eager to exploit this and ready to fill the void.
