Politics & Policy

‘Repeal and Replace’? Try ‘Tweak and Move On’

(Photo: Barbara Helgason/Dreamstime)
The health-care debate is no longer about the existence of government subsidies, mandates, and regulations — they’re not going anywhere.

Two Junes ago, when the Supreme Court upheld, 6–3, a challenged provision of the Affordable Care Act, Chief Justice John Roberts, writing for the majority, vented: “Congress wrote key parts of the Act behind closed doors. . . . Congress passed much of the Act using a complicated budgetary procedure known as ‘reconciliation,’ which limited opportunities for debate and amendment, and bypassed the Senate’s normal 60-vote filibuster requirement. As a result, the Act does not reflect the type of care and deliberation that one might expect of such significant legislation.” Now, however, Republicans run things, so . . . 

In 2009, President Obama ignited a debate that has been, for many members of Congress and their constituents, embarrassingly clarifying. Back then, most people stoutly insisted that they did not want a “government-centered” health-care system. But even then, approximately half of every dollar spent on health care came from the government. Today, the 55 million Medicare beneficiaries approximately equal the combined populations of 26 states; the 73 million Medicaid recipients approximately equal the combined populations of 29 states. Government’s ten thumbs are all over health care.

Although an Atlanta Journal-Constitution poll showed that health care was “extremely” or “very” important to 81 percent of voters in the recent Georgia congressional election, neither candidate stressed this issue. Both were confronted, as all congressional candidates will be in 2018 and ever after, with this fact: No health-care policy is comprehensive, comprehensible, and inoffensive to all intense groups.

Health care only relatively recently became worth fighting over. In 1900, Americans spent almost twice as much on funerals as on medicine. Most people were born at home and died at home, and medicine’s principal function was to make ill people as comfortable as possible while nature healed them or killed them. Hospitals often were lethal infection factories, hence the common report, “The operation was successful but the patient died.” In his The Rise and Fall of American Growth, Robert Gordon notes that “even victims of railroad, streetcar, and horse cart accidents were largely taken to their homes rather than to hospitals.” In 1900, only 5 percent of American women gave birth in hospitals. And “a ‘degree’ in medicine could be obtained for between $5 and $10, its cost depending on the quality of the paper on which the diploma was printed.” Between 1890 and 1950, the great improvement in mortality rates owed much to social improvements (better hygiene, sanitation, food handling, etc.) and little to doctors, hospitals, or drugs.

In 2009, there was no national consensus that insurance should be available to people with “pre-existing conditions.” There now is such a consensus, partly because of the obfuscating phrase: Insuring people with “pre-existing conditions” means insuring people who are already sick. Which means that what they are getting is not really insurance — protection against uncertain risk. The consensus might be right, but its logic makes the insurance model increasingly inapposite.

A market-driven health-care system with government at the periphery would implement the lesson of Social Security: Government is good at sending checks to identifiable cohorts. It should send support to those who need it for purchasing premiums, then get out of the way.

Even if the tweaks constitute significant improvements, Obama will have been proved right when, last October, he compared the ACA to a ’starter home.’

But Obama, who once said he preferred a single-payer system, flinched from the really radical reform we need — a move away from broad reliance (about 180 million Americans) on employer-provided health insurance, which, in an expensive fiction, is not taxed as what it obviously is: compensation. Partly because of this system, health-care consumers are not shoppers and market signals are weak and few.

Suppose that instead of providing health insurance, employers gave employees money to buy groceries. What would grocery stores look like? There probably would be no prices. To see why, ask yourself: When your doctor wants to perform a particular test, do you ask, “How much will it cost?” If you do, you are eccentric. Besides, the doctor probably does not know.

Perhaps for policy reasons, and certainly for political reasons, it is impossible to unwind reliance on employer-provided insurance. But this fact, combined with the “pre-existing conditions” consensus, means that henceforth the health-care debate will be about not whether there will be a thick fabric of government subsidies, mandates, and regulations but about which party will weave the fabric.

So, “repeal and replace” will be “tweak and move on.” And even if the tweaks constitute significant improvements, Obama will have been proved right when, last October, he compared the ACA to a “starter home.”

READ MORE:

Republicans’ Grim Health-Care Fairy Tale

The Republican Health-Care Mistake

Bipartisan Agreement on Health Care Masks a Deep Divide

George Will — George Will is a Pulitzer Prize–winning syndicated columnist. His email address is georgewill@washpost.com.

Most Popular

Politics & Policy

Broward’s Cowards

It is impossible to imagine circumstances under which Broward County sheriff Scott Israel could attempt to perform his duties with the confidence of the public. He should resign immediately, and if, as he promises, he refuses to go quietly, then he should be shown the door by the people he professes to ... Read More
Culture

Courage: The Greatest of Virtues

EDITOR’S NOTE: The following is Jonah Goldberg’s weekly “news”letter, the G-File. Subscribe here to get the G-File delivered to your inbox on Fridays. Dear Reader (Or Listener), As the reporter assigned the job of writing the article about all of Sidney Blumenthal’s friends and supporters told his ... Read More
Immigration

My American Dream

This morning, at 8 a.m., I did something I’ve wanted to do for as long as I can remember: I became an American. I first applied for a visa in early 2011, and since then I have slowly worked my way through the system — first as a visa-holder, then as a permanent resident (green card), and, finally, as a ... Read More
Politics & Policy

CNN’s Shameful Town Hall

CNN recently hosted an anti-gun town hall featuring a number of grieving children and parents from Stoneman Douglas High School in Parkland, Fla., who aimed their ire at the National Rifle Association, politicians peripherally associated with the NRA, and anyone who didn’t say exactly what they wanted to hear. ... Read More
U.S.

The Gun-Control Debate Could Break America

Last night, the nation witnessed what looked a lot like an extended version of the famous “two minutes hate” from George Orwell’s novel 1984. During a CNN town hall on gun control, a furious crowd of Americans jeered at two conservatives, Marco Rubio and Dana Loesch, who stood in defense of the Second ... Read More