After running around in circles for seven months, accepting the Democrat vision of health care as their own, and sabotaging our messaging on free market health care, will Republicans finally press the reset button and start over? Will they finally pass what they should have proposed in January without spending half the year making Obamacare great and popular again?
Late last night, both President Trump and Senate Majority Leader Mitch McConnell indicated that they would drop the GOP’s version of Obamacare and call up the clean repeal bill from 2015. If McConnell’s intent is to merely dispense with the bill and move on, then the 2015 bill, which is not quite full repeal, is a bad strategy. However, if this is being used as a clean shell to build out full repeal and a vision of consumer-driven health care (not just crony medical insurance) in an open and transparent amendment process, then it will be well worthwhile.
The good thing about the 2015 bill is that it makes no prejudgment on what will “replace” Obamacare, muddling and distracting from the immediate need to repeal the malignant law. It only contains repeal provisions, with a two-year delay for implementation. The only shortcoming of the bill is that it doesn’t repeal the most important element — the actuarily insolvent regulations — but only the entitlements and the mandates.
In October 2015, I expressed opposition to the bill because my concern was that it would become the ceiling, not the floor, for repeal and that Republicans would use it as a baseline from which to codify Obamacare’s regulations. Broadly speaking, that concern has been proven well founded, as Republicans have embraced guaranteed-issue, community rating, and the other core regulations that have not only sent prices skyrocketing, but created an unstable monopoly for the largest insurers.
However, now that this entire effort to pass phony repeal has failed, there is a great opportunity in starting over with the 2015 bill, which every Republican undeniably supported two years ago, and just adding the repeal of the regulations through an amendment.
Part of the reason why the regulations weren’t added to the 2015 reconciliation bill is that some were concerned that the regulations would be deemed as “extraneous policy” unrelated to budgetary matters and ruled inadmissible to the broader bill by the parliamentarian. Given that Republicans wanted a quick messaging victory to get a bill to Obama’s desk and not to haggle with the parliamentarian, they kept out the regulations.
Now that has all changed. Every iteration of the GOP bill in the House and Senate contained some inadequate tweaking of a few of the minor regulations, which lays waste to the notion that they can’t be addressed in a budget reconciliation bill. To paraphrase Democrats, that all of Obamacare can be repealed through reconciliation is now “settled science.” The reason Republicans didn’t add the bulk of regulatory repeal to the bill until now is because they don’t want to repeal the regulations, not because they can’t do so procedurally. Thus, there is no excuse not to call up the 2015 bill as an agreed-upon baseline and immediately add repeal of the regulations.
The difference between the 2015 bill and the GOP’s collapsing current bill is the difference between a glass half empty of water and a glass half full of poison. The current bill accepts the entire premise of statism and insurance cartels controlling health care for 100 percent of the population, and Republicans would own that framework as their free market “replacement” plan. The 2015 bill, by contrast, is merely half empty, with no added malignancy that prevents its improvement. Whereas the current bill is analogous to building a house that already has a putrid-smelling taxidermy office in the living room, the 2015 bill is merely a fresh new frame without all the rooms and the electricity. Those basics can and should be added.
And what should we do with that frame?
It’s time to move beyond the crony government-sponsored insurance and actually discuss health care — the quality, the delivery, and the need for innovation. Medical insurance is not health care — and certainly, the existing system distorted by the government is not. It’s time for an open amendment process where conservatives can address every aspect of why health care doesn’t work like a regular market and who is responsible for the market distortions. It’s time for consumers to be in the driver’s seat of health care decisions and time to free doctors from the nonsense of government regulations and the insurance-government complex eating up their time and energy and setting prices. It’s time for price transparency. It’s time to address HIPPA, EMTALA, ERISA, and all the other unfunded liabilities on the medical profession.
It’s time to provide a true vision of what providers and patients can do together when government, lobbyists, trade associations, and the insurance cartel are cut out of the equation, instead of cutting the consumer out altogether.
The only way to help the chronically ill, as well as everyone else, is to cut out the market distortions and lower the price of health care itself so that a fraction of the $1.6 trillion we already spend on government-run health care can go directly to paying the medical bills of only those who need it, instead of lining the pockets of the insurance cartel and making both health care and medical insurance unaffordable for everyone.
This discussion can only commence if McConnell is willing to break out of the existing paradigm of merely debating Medicaid, government subsidies, and government price-fixing. It’s time to let the 2015 bill stand for itself and serve as the impetus for a true replacement plan that will not only repeal Obamacare but repeal all of the lobbyist-driven laws that destroyed health care prior to Obama. It’s time to put “care,” “consumers,” and “affordable” back into health care.