Politics & Policy

The Republican Health-Care Mistake

Speaker Ryan and Senate Majority Leader McConnell at the White House in February (Reuters photo: Jonathan Ernst)
The congressional GOP made a grave political error, and now finds itself in a no-win situation.

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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