Current reality of repealing and replacing Obamacare
Don’t think that once Obamacare is repealed and the placeholder is operating that Republicans will be let off the hook on this issue. The GOP still needs to re-imagine the entirety of American healthcare so that it works for all Americans and is sustainable.
Now is the time to be thinking about a solution to healthcare in America that replaces Medicare, Medicaid, the healthcare elements of Social Security. And that can’t be done at the state level.
It's time for our elected officials to go back to work. Having touched this third-rail of American politics, the GOP could suffer for it just as Democrats have unless they solve it once and for all.
After years of fervent promises to repeal and replace "Obamacare," President Donald Trump and GOP congressional leaders buckled at a moment of truth Thursday, putting off a planned showdown vote in a stinging setback for the administration.
The Republicans need to settle down a bit concerning the repeal and replacement of Obamacare. The pressure is increasing to change Trumpcare / Ryancare to capture uneasy Republican votes.
Soon, the GOP may have a passable bill because it damages fewer people; and that will allow for the repeal of the Obamacare. President Trump will sign anything credible to move on to taxes, regulation, immigration and defense.
For the last three or four years I've been proposing a simple five point plan:
1. Health savings accounts that would be topped-off directly by government for the very poor and neediest.
2. Beyond the HSAs that people would use to pay for all routine medical services, true catastrophic portable health insurance.
3. Tort reform.
4. Do away with government designed insurance and state insurance barriers.
5. Do away with most government regulation but require transparency of pricing.
When completed with the next two phases the House proposal would take us precisely there. Even the Cadillac Tax is important to it because that is the gimmick that would finally take us to a full market driven healthcare.
Because the Cadillac Tax is not indexed, all company plans will eventually be affected, and with the 40% Cadillac tax the health benefits companies give their employees will no longer be deductible. That will lead companies to instead give employees and workers the equivalent extra pay, which is deductible to the companies. Workers would then insure themselves. Since it only goes into effect in 2025 there would be time to adjust it in view of how the rest develops.
The GOP's failure was allowing progressives to create a new entitlement. Once they did that, Republicans can’t just replace it after having conferred it: they must come up with something that works better but is sustainable.
Republicans can’t ignore the millions of uninsured that Trumpcare / Ryancare will create. There is no way that the GOP won’t pay a political price for that.
Lesson learned: don’t let progressives create new entitlements and then merely complain about it.
It is a good sign that Republicans are publicly debating the legislation. The problem they have is those weak Republicans who have allowed themselves to be backed into the progressive corner: let the opposition define the issue and control the media and polls, and then spend the next few days apologizing for being Republican.
Republicans have to show both backbone in resisting leftist pressure, but also flexibility in not letting the perfect be the enemy of the good. Any legislation Republicans pass will be better than the Obamacare it replaces.
Politics, when allowed to function properly as it hasn’t for eight years, is messy, icky and you get sausage all over you. But the real closer will be to pass something without recourse to reconciliation, the ramming mechanism that Democrats used in 2010 to get Obamacare past the Senate.
That means you need to co-opt enough Democratic Senators to avoid the filibuster. And that will require some Democrat participation.
If Ryan signals that his bill isn’t the end of the line on healthcare, that we need a permanent fix through a bipartisan process but done by a commission over two years, where Democrats will get their chance to affect it materially, then the Ryan-McConnell-Trump axis could just squeak some version of Trumpcare / Ryancare by. And that would be just great for an America that needs to move on to other priorities that progressives are going to hate much worse.
If we must repeal and replace, I see no chance that the Democrats would participate in any effort to “clean up” the “replace” part. It’s just too easy to stand on the sidelines, insist on retention of Obamacare and watch Republicans cut themselves to pieces.
However, if the “replace” was understood to be a place-holder with a permanent fix being the charge of a commission that sat for two years and that would be honestly bipartisan, you might coax enough individual Democrat Senators from red states to lend bipartisan cover to “replace” now – and even make some suggestions about it. Short of that, why toss Republicans a lifeline?
If Ryan gets “replace” through thinking that this is the sum of the Republican effort to fix healthcare, it’ll need to be as one-sided as the ramming of the ACA was in 2010.
The purely fiscal arguments presented are compelling. But, pause a moment and consider that this argument ignores the human toll exacted by securing the fiscal benefits, which ultimately translates into political costs. This un-bylined staff-editorial makes similar steady-state assumptions as the CBO makes in its scoring of Trumpcare / Ryancare and it misses vast political considerations.
Republicans have a full docket of transformations in play and planned, including immigration, regulation, taxes, trade and defense – and getting Europe to more effectively defend themselves for the first time in over 70 years, allowing us to focus a more robust military on matters other than the Maginot Line of Central Europe. If Republicans lose their undivided GOP government, and just as seriously if they lose their dominance at state and local levels, all that is imperiled.