The effort by congressional Republicans to repeal and replace Obamacare hit a major roadblock last week, as GOP senators on the left and right sides of the caucus declared their opposition to majority leader Mitch McConnell’s latest proposal. It is hard to blame them for their unease. Obamacare was a hodgepodge of half-measures and false starts, but compared with the GOP alternatives it looks like a masterpiece of symmetry and sophistication.
There is a natural inclination to blame particular individuals for this failure. Many theories abound. McConnell did not write a good bill. Conservatives like Mike Lee and libertarians like Rand Paul were unwilling to take half a loaf. Moderates like Lisa Murkowski were unwilling to follow through on the promises they made when Barack Obama was president. And so on.
Without discounting these theories, it is important not to overlook the bigger picture. Namely, the GOP has proven itself over the years to be a poor vehicle for entitlement reform. While the party can generally be relied upon to oppose the statist ambitions of liberal Democrats, it still lacks “the vision thing,” as George H. W. Bush famously put it. The Republican party does not have a clear, salable view of what entitlements should do in our society, or how they should do them. Little wonder, then, that the effort to offer an alternative to Obamacare has been mostly incoherent.
Our entitlement system has at least four major defects. First, benefits flow to people who really should be able to take care of themselves. This was a key complaint about the Obamacare expansion of Medicaid, whose initial purpose was to supply a backstop for the indigent and their dependents. Similarly, Medicare and Social Security were created when seniors were the most impoverished age cohort; now the oldest Americans are also the wealthiest, yet their benefit levels have increased over the years.
Second, providing benefits to the wealthy or able-bodied discourages good habits like thrift and hard work. For instance, many voters are under the mistaken impression that their contributions to Medicare and Social Security cover the full scope of benefits they eventually receive, which discourages saving for retirement and puts more pressure on the state.
Third, the design of many entitlements reflects old political calculations, rather than the most efficient way to transmit necessary benefits. The most extreme example of this is the Supplemental Nutrition Assistance Program, which is housed in the Agriculture Department—mainly for political purposes. In the 1960s a logroll between urban and rural members of Congress yoked food stamps to farm subsidies and placed the entire edifice in the USDA to secure the bargain. Moreover, Medicare was a program of runaway spending from its earliest days in part because the original law created an open-ended commitment that massively inflated costs. The effects of this fateful decision linger to this day.
Fourth, our entitlements invest undue political power in mediating interest groups. The government does not provide benefits directly, and so employs private parties, which in turn acquire power to influence the government. For instance, the doctors’ lobby, which initially opposed Medicare back in 1965, is so ingrained in the system that it now writes upwards of 90 percent of the reimbursement rates for Part B. This institutionalization of conflicts of interests increases the costs of entitlements and corrupts the republican character of our government.
Entitlement reform, in theory, would be an effort to ameliorate such problems for all of the major federal entitlements—not just Obamacare, but Medicare, Medicaid, Social Security, veterans’ benefits, unemployment insurance, and the smaller forms of subsidy. The approach might need to be piecemeal, but the goal would be constant movement toward a system that dispenses benefits in a more rational manner, aiding those who need it while keeping costs to taxpayers low and minimizing the incidence of corruption.
Such an effort would have to include a pedagogical function, as well. The average voter does not understand how entitlement programs work, much less how they fail to work. So a call for reform will inevitably fall upon deaf ears unless accompanied by a public relations campaign.
All else being equal, this could be a bipartisan effort. After all, there is nothing inherently objectionable about distributing government benefits in a fair and sensible manner. But the devil is in the details. Modern conservatives and liberals disagree on what constitutes genuine need. The technocratic know-it-alls at the top of the progressive architecture seem intent on promoting dependence on the government, and by extension on themselves. And the partisan effort to expand the welfare state requires progressives to elide the inefficiencies of the current system. That leaves the Republican party as the only reform game in town.
Unfortunately, the GOP has proven not to be up to this challenge. While there are a handful of Republicans—House speaker Paul Ryan comes to mind—who have seriously pursued entitlement reform, it is a message that, as a whole, the party has not advanced. Quite the opposite, in fact. While campaigning for president, Donald Trump promised not to cut Medicare and Social Security, suggesting the programs could be brought into line by trimming waste, fraud, and abuse, and promoting economic growth. This is simply not the case.
More broadly, Republican efforts to reform entitlements—halting as they have been—seem inevitably conjoined to an effort to cut taxes. In the early 1980s, when federal income tax rates were burdening the middle class, this could be seen as a populist position: Let’s help the working man take home more of his pay, and insist that nobody free-rides on Uncle Sam. But federal taxes have been cut repeatedly in the intervening decades, making it almost impossible to cut them more without primarily aiding the wealthy. This is about the worst possible message, from a public-relations angle, as it makes Republicans look like Robin Hood in reverse.
It would be understating the scope of this failure to suggest it is a problem of bad salesmanship. Republicans have little to sell, anyway. Far from spearheading a comprehensive effort to bring our Frankensteinian welfare state to heel, the party cannot even get the small stuff right. Conservative policy experts have done good research on health care in recent years—no doubt spurred by their dissatisfaction with Obamacare—but the congressional GOP seems to have largely ignored their endeavors. The repeal-and-replace plan the House produced was met with groans of disappointment from conservative policy wonks, and the Senate alternative fared little better. Now that the repeal-and-replace initiative has run aground, one would think that smaller reforms would be in the offing—but one would be wrong. The GOP is simply not up to this relatively narrow task.
In sum, the Republican party is generally not serious about entitlement reform. This explains why, despite the resurgence of the party’s political fortunes in the last 40 years, it has mostly left the system intact—the welfare reform of 1996 being a notable exception. When confronted with an opportunity for reform, the party more often undertakes initiatives that expand and entrench the current regime. This creates a vicious cycle: Halting and equivocal in its efforts, the party fails to educate the electorate on the need for reform, which encourages wavering legislators to hedge all the more.
What is needed is a GOP that is as committed to reforming entitlements as the Democrats are to expanding them. Democrats knew, in 2009-2010, that Obamacare was politically unpopular and might undermine their personal political aspirations. But many of them voted for it, anyway. Why? Because expanding federal benefits is embedded in the DNA of their party and is a central element of the modern progressive’s self-conception. Republicans have no such core conviction, and it shows.
Jay Cost is a senior writer at The Weekly Standard.
