By Michael Brendan Dougherty
Friday, June 23, 2017
Republicans in the House and Senate have made a grievous
political miscalculation: They have staked themselves to doing something about
Obamacare, yet they can barely feign interest in the details of health-care
policy, and don’t have a clear endgame other than trying to cut costs and taxes.
That alone explains the guilty-looking secrecy with which they’ve conducted
this process from Day One.
To clarify the stakes for them, here’s the bald truth: No
American health-care reform bill will be popular unless it lowers costs or
makes obtaining insurance easier. And no bill will be popular that upsets the
current health-insurance arrangements of moderate- to high-income earners. It
is almost impossible for disinterested wonks
to come up with a bill that satisfies those competing conditions; the congressional
GOP never stood a chance.
If Republicans pass a major alteration to Obamacare they
will, in the mystical jargon of our business, “own” all the problems of the
American health-care system thenceforward. That is, of course, why they opposed
a larger federal intrusion into health care, fearing that, like their British
cousins in Parliament, they’d soon be where people turned whenever a scheduled
surgery was delayed.
They were not ready for the argument that was obviously
coming for them, the one that says, “Without Obamacare, my very sympathetic
friends and I would be dead today. And without Obamacare, my very sympathetic
friends and I will die tomorrow.” The argument is mostly fallacious, though it
does make for great drama. But Republican lawmakers, if they even know how to
spot the fallacy, are too stupid, cowardly, or witless to respond to it
gracefully. So now they are left rushing out of their offices to catch flights
home, where angry activists are likely to be waiting. The overall level of
punishment for Republicans will be directly related to the number of people
whose health-care arrangements are thrown into doubt. People are extremely
anxious about being covered and obtaining coverage is often a pain.
If Republicans were as confident in their proposals as
the Wall Street Journal editorial
board is, they’d be able to explain how tax credits and some deregulation will
increase the rate of health-insurance coverage. But most can’t and are wary of
even trying, given the way that the Congressional Budget Office has panned
every GOP proposal.
The problem is that Republicans have thought about
Obamacare almost exclusively in fiscal terms. That’s almost understandable; the
law greatly increases voters’ tax burden, its exchanges don’t work without an
endless infusion of federal cash, and its thicket of regulations is
nightmarish.
But as it is the Senate bill basically accepts most of
Obamacare’s premises about how health-coverage works, while changing its
funding mechanism and hoping that a few excised regulatory clauses will keep
health-care inflation from eating everything in the federal budget. And as
such, it is likely to prevent future Republican Congresses from passing a
better, more conservative health-care reform bill, while unleashing a tsunami
of political discontent on this Congress heading into next year’s midterms.
If I were President Trump, I would try to save Mitch
McConnell and Paul Ryan from themselves by rejecting this bill, with a strong
suggestion that they have a good, long, hard think about it and try again in
2019. Then I would demand that the Republicans move on to infrastructure
spending and tax cuts, perhaps pairing them together. Both have more potential
to spur employment, labor-force participation, and economic growth.
Anyone with political sense should remind the GOP
legislators that they govern a closely divided nation, and that perhaps a
quarter of its citizens quite literally fear the president who leads their
party. Doing something popular might help. It’s both the trouble with and the
glory of democracy that this is true: Save the truly heavy lifts for when you
have political capital to spare.
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