Republicans have every incentive to come up with an appealing menu of health care policy alternatives to sell voters. But the notion that they need to assemble these ideas into a single Washington-centric reform plan that can be plugged into the void left by Obamacare’s demise is a puzzling one.
According to Mike Allen, in the new insider account of ObamaCare, America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, Steve Brill writes: “Nearly five years later, President Obama would tell me … ‘In hindsight, … there should have been one central person in charge, a CEO of the Marketplace.’”
What does a contrived “marketplace” built on cronyism, coercion, and rent seeking, paid for by tax subsidies and governed by a regulatory structure that makes any genuine competitive pricing impossible need to be successful? More top-down bureaucratic management, of course.
The president’s comment reflects his inability to grasp what a marketplace actually is, but it’s also a reminder that one of the most distasteful aspects of ACA is its centralized structure—which, for most liberals, was the point of the project. Even voters who aren’t directly hurt by ObamaCare tend to dislike the idea of DC dictating what their coverage looks like. For many voters, ObamaCare represents every problem with health care in the United States. Gallup’s recent polling found that Americans now say that the “biggest problem” in America is “the government.” And they’re talking about federal government.
I only bring this up because as the GOP Congress starts work, the media is already asking why conservatives haven’t been able to cobble together a national health-care reform platform with a catchy name. Here’s Politico reporting on the GOP’s inability to bridge its differences:
The GOP conversations so far are preliminary, and a breakthrough isn’t imminent. Various Republican proposals have been put forth over the years, but forging agreement requires bridging deep ideological differences among Republicans about the scope of a plan, the role and responsibility of the federal government in health care, and how much to money to spend.
They don’t need a breakthrough. The fact is, Republicans have offered a number of plans with varying levels of free-market reforms, but Americans aren’t in the mood for another wide-ranging effort from Washington. There’s almost no chance of Congress coming together on a set of ideas anyway. There’s even less of a chance that Congress can accomplish anything on the issue while Barack Obama is still president, anyway.
But even if they could create some consensus, the argument for deregulating ObamaCare is far more powerful than trying to sell “means-tested tax credits” —and another few dozen compelling ideas—at the same time. What’s more important is freeing states and allowing them to implement these ideas when possible on their own. If Vermont’s experiment with single-payer reform crashes and burns, it won’t take the entire country with it. Republicans may have some terrible ideas, as well. Let’s see how they work elsewhere.
ObamaCare may well survive King v. Burwell, the legal challenge that could sink ACA by forcing the administration to follow the law and cut subsidies from government “marketplaces” in states that didn’t surrender to White House inducements. Only 13 states have their own marketplaces. If it doesn’t, though, Republicans will have a glorious chance to deregulate and open up markets. You know, fix our broken health care system. If not Burwell, they’ll have other shots at it. The chance of ObamaCare’s popularity growing over the next few years is slim. Most of the painful taxes were designed to be implemented during Obama’s second term, once the law had already turned into a giant welfare program that would be almost impossible to dislodge. (That’s what they mean when they say “it’s working.”)
As a matter of politics, and good policy, there is no reason for the GOP to surrender to the formulation offered by Democrats. Today’s conversation dictates that federal policy should be replaced by other federal policy—or, preferably, more federal policy. But in reality there’s no one clamoring for more giant reforms, and there’s no reason for Republicans to offer any.