As the dust settles around the wreckage of the latest Senate Republican effort to “repeal” and replace the Affordable Care Act, learning from political failures should take priority over placing blame. Deep structural issues have caused Republicans to continue to struggle on health care, and addressing those issues will be a way to make a health-care-reform effort that will be more popular and deliver on key policy goals. Here are five lessons that might be learned:
Make the health-care debate about the future — not the past: The goal of the GOP on health care should not be turning the clock back to 2009, but improving medical care for 2017. Redressing some of the failures of the ACA will be part of that process of improvement, but eliminating the ACA alone will not be enough from a policy perspective (and, for the moment, that elimination seems fairly dead as a policy option).
Go bipartisan: On health care, 60 votes might be easier to get than 50. Trying to push through health-care reform on a party-line vote limits Republicans to reconciliation, which means that their efforts at health-care reform will mostly have to be confined to finance, which is precisely the most politically toxic area for the GOP. The Democratic party might have partisan incentives to frustrate any prospect of legislative accomplishment for Republicans, but Democratic centrists might have a hard time resisting middle-of-the-road, market-oriented proposals to expand the range of health-care options. For example, proposals to increase funding for medical residencies, expand the range of over-the-counter medications and devices, and eliminate certificate-of-need laws could get strong bipartisan buy-in.
Remember that entitlement reform is distinct from health-care reform: Even under the best of circumstances, entitlement reform is a tightrope walk, but party-line entitlement reform is walking the tightrope while juggling chainsaws. Democrats took that walk in 2010 with the passage of the Affordable Care Act, and the party has some bloody stumps to show for it. Republicans are quite reasonable to want to avoid similar self-inflicted mayhem. Because entitlement reform can be so dangerous, Republicans might have to make a choice between trying to include entitlement reform as part of the health-care bill and passing a health-care bill at all. Medicaid could certainly stand reforming, but that reform will need some sign-off from congressional Democrats.
More targeted measures might slowly advance the ball in the right direction (a far better option than giving the other team an easy interception).
The debate over health-care reform has now dominated the first quarter of the 115th Congress. Much of this debate has been about how to stand the political pain of passing an unpopular bill on a party-line vote. With some imagination and legislative diligence, though, Republicans could find themselves in the much better position of trying to share the credit for making measurable improvements to the health-care system.
— Fred Bauer is a writer from New England. He blogs at A Certain Enthusiasm.