Posted by Curt on 21 April, 2017 at 11:04 am. 21 comments already!


Dan McLaughlin:

House Republicans are reportedly ready to return any day now to health-insurance reform after the spectacular failure in late March of the American Health Care Act, the resoundingly unpopular bill to “replace” the long-unpopular and misnamed Affordable Care Act. This time, they need to deliver: After seven years of promises to repeal Obamacare root and branch, the party can’t go back to the voters with nothing more than a participation trophy.

It won’t be easy, and it may be agonizingly slow, but the Democrats didn’t get Obamacare passed overnight: They spent 40 years battling to pass a universal-health-insurance scheme, and the ACA passed only in March of Barack Obama’s second year in office, after several false starts, much arm-twisting, and the death of a key Senate supporter (Ted Kennedy) who was replaced by a Republican opponent of the bill. Going home empty-handed would be an admission that Republican politicians just don’t care as much about stopping big government as Democrats care about implementing it — a suspicion already all too common among the party’s voters.

Having failed the first time, Republicans should take the opportunity to change their approach, rather than just tinker with the details of the bill. In the process, they should consider learning some of the lessons of why Obamacare was so unpopular for so long, and why the voters and Republican congressmen rebelled against the AHCA as well. And they may have to resort to drastic measures to bring Democrats to the negotiating table.

Lesson #1: Value Modesty and Experience

The essential element of conservatism, more than any fixed principle or ideology, is experience. Conservatives believe in democracy, free markets, federalism, tradition, and the rule of written law for the same basic reason: These are all ways to bring the practical experience of the largest possible number of people to bear on the making of important decisions, rather than leave big decisions in the hands of a few unaccountable “experts.” And one of the important ways to demonstrate a decent respect for all these values is to take the world as it is – not as we might like it to be – and show some modesty about what we can accomplish in changing it, especially by the action of big, complicated government programs.

Modesty means recognizing that nobody in Washington is smart enough to design a better health-insurance system on his own. The best system is one that is relatively simple, doesn’t try to do everything at once, and leaves the largest possible amount of power in the hands of individual consumers, and the power of experimentation in the hands of all 50 states. A system that is designed to solve all today’s problems for all time — even if it succeeded — would cast in stone an inability to respond to tomorrow’s problems until they reach crisis proportions.

Complexity also has its own costs: Complex programs are hard to explain to the voters, their effects are harder to project and measure, they require citizens and companies to hire expensive lawyers to explain, they can more easily be derailed by a legal challenge to one part of the program, and having a blizzard of interlocking rules makes it hard to fix one problem without having to revisit the entire contraption. And bills that try to do everything are harder to pass, because the more things they try to do, the more people in Congress find at least one thing they need to oppose. Friends come and go, but enemies accumulate.

We saw all of these play out in Obamacare, from Nancy Pelosi’s frustrated insistence that “we have to pass the bill so that you can find out what is in it” to the messy drafting errors that led to the King v. Burwell Supreme Court case, to the weirdly staggered implementation of the system to satisfy the Congressional Budget Office, to Democrats’ complaints that the Supreme Court unsettled their plans by striking down part of the Medicaid expansion, to the profusion of rules that had to be waived or delayed during implementation.

Now, boldness is an important virtue in politics, and sometimes it is required for Republicans; think of Reagan’s tax cuts, defense buildup, and Star Wars, or Rudy Giuliani’s aggressive steps to clean up New York, or Scott Walker’s breaking the back of public-sector-union liberalism in Wisconsin. But political boldness does not require policy hubris. Fundamentally, people generally don’t vote for Republicans to change the world; they tend to vote for Republicans to stop Democrats from getting drunk on Utopianism. George W. Bush, for example, was elected to cut taxes back to pre-Clinton levels, restore the military, and pursue education reforms; the voters supported his taking of more drastic national-security steps when events demanded them, but they ultimately soured on Iraq in large part owing to the perception that Bush was spending American lives in pursuit of an overly ambitious agenda rather than a strictly necessary war. Paul Ryan should not want to repeat that political dynamic.

A major reason Americans rebelled against Obamacare from the very beginning was its combination of ambition, novelty, and complexity. Most Americans understood only a fraction of how the law was supposed to work, but they knew that it was a thousand-plus-page paper blob designed to affect the health care of every American, creating lots of new rules and bureaucracy, spending colossal amounts of money, and launching us into uncharted waters.

This was a disastrous misreading of the popular mood in 2009, which was very much open to taking a sledgehammer to the task of radically reworking the financial sector — after the 2008 financial crisis – but not health care. Most people were reasonably happy with their health insurance. Had Obama pursued a more modest strategy of gradually expanding Medicaid and passing a series of individual liberal-leaning reforms, he would probably have retained a lot more political capital, gained more Republican votes for individual bills, and reduced the carnage that down-ticket Democrats suffered at the polls in 2009, 2010, 2011, 2014, 2015, and 2016.

Moreover, health care is far from the only area in which voters (especially Republican-leaning voters) have rebelled against massive, thousand-page “comprehensive” do-everything bills: From immigration to Dodd-Frank to the stimulus, voters tend to see complex legislation as neither honest nor competent. It’s not honest, because complicated laws are more likely to be infested with lobbyist-driven special-interest-group giveaways. And it’s not competent, because nobody trusts the “experts” in Washington to have all the answers.

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