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.
Abolish OBAMACARE, the EEOC,EPA,UN, ESA, and the DNC
Why so testy, Darell? It was a perfectly straightforward question. From The Hill, Monday, April 21st:
Issa: ObamaCare repeal position ‘none of your business’
Republicans—who now have majority control of both the House and the Senate, plus a guy with an “APPROVED” rubber stamp in the White House willing to sign just about anything—still can’t accomplish the one thing they’ve made their highest priority in every election since 2008.
Apparently they’re their own problem. Or maybe Darell’s new shoes are too tight?
Also from The Hill, today, May 2, 2017:
Poll: Majority of voters in 13 GOP districts oppose defunding Planned Parenthood—not to mention the GOP’s current Obamacare replacement bill.
But please, don’t let that stop you.
Republicans just moved closer than ever to passing their Obamacare overhaul
That would be the “MacArthur amendment.”
So, here’s the bottom line on the MacArthur amendment: It removes guaranteed protection for preexisting conditions; it restores gender premium inequality; and it allows state governments to do those things by default, since inaction on the part of the federal government constitutes endorsement of state-level decisions.
Here’s where the $8 billion comes in: Republicans approving the bill would be protected from an immediate backlash at the polls over the next couple of elections, because the dire consequences of the elimination of Obamacare provisions could be delayed until the money is exhausted. When those consequences inevitably hit, it would take action on the part of Congress to remedy them—and we’ve all seen how quick Congress is to act on healthcare. There could be a new round of political blame-shifting, too.
Essentially, they’d be doing a reset back to the screwed up pre-Obamacare situation. Except for lower past premiums, of course. Medical costs and insurance premiums had already been skyrocketing for years before the Affordable Care Act came along.
Ah, yes. Enough House republicans may now have been wheedled, badgered, coaxed, and cajoled into lining up to pee on a live spark plug. The results could be shocking.
With $8 Billion Deal on Health Bill, House G.O.P. Leader Says ‘We Have Enough Votes’
Tomorrow, we’ll find out for sure.
GOP ‘giddy’ as Obamacare repeal vote nears
So, republicans will lose control of Congress in 2018, and the presidency in 2020, sometime after which we will likely see the introduction of a single-payer system—because their changes will create chaos in the healthcare industry, skyrocketing premiums for older Americans and families with serious medical problems, and political disaster at the statehouse level.
But not to worry! The people who are doing this will have their hefty pensions, their lobbying jobs and rewards after leaving office, and in the meantime have cleverly exempted themselves from the adverse effects of the bill.
We’re going to give them something that’s both cheaper and better. Right?
May 3, 2017: AMA Warns Proposed Changes to AHCA Do Not Remedy Bill’s Shortcomings
On the bright side, republicans will totally own the consequences.
@Greg: Everyone that had insurance under Obamacare were about to lose their insurance.
and of course, none of that happened back when Obozo was trying to get Obozocare authorized. right?
@Bill… Deplorable Me, #9:
Everyone? Typical total republican bullshit. There were 5 states out of 50 that were down to a single Obamacare insurance provider—Alabama, Alaska, Oklahoma, South Carolina and Wyoming. Nine additional states were down to 2 providers—Arizona, Delaware, Hawaii, Mississippi, Nebraska, New Jersey, North Carolina, South Dakota, West Virginia. There were no states that had no providers at all.
A minimum of 10 million additional Americans presently have insurance owing to Obamacare provisions that had no health insurance before. Most estimates run higher than that figure. 24 million is a number commonly mentioned.
Republicans have been claiming Obamacare is on the verge of total collapse every time they’ve opened their lying yaps—while simultaneously doing everything in their power to assure that such a thing would happen. They haven’t lifted a finger to address problems that could have modified and strengthened the system. Nor have they calculated what the results of their “replacement” will be for millions of Americans and their families who benefited because of Obamacare provisions. They don’t want to know, and they sure as hell don’t want their constituents to know. They surely suspect people are going to get royally screwed, however, because they’ve tucked wording into the legislation to protect themselves from what they’re trying to do to everyone else. They’ve quietly given themselves an exemption.
Health care bill ‘shameful,’ ‘harmful,’ medical groups say
Not true. Very prejudiced reporting. It does not remove guaranteed protection for preexisting conditions if you have had continuous coverage. For example if you are covered by employer insurance and change to the new system, you will still be covered. All the new bill does is prevent people from not buying insurance until they get a costly condition and then running out and buying insurance just to cover that new condition. So if you had a policy that covered it and you just change companies, you will still have the coverage.
There are other items you apparently misunderstand, I don’t have time to teach a class right now.
But there will now be nothing to prevent the insurance company from quadrupling an unprofitable person’s monthly premium—or worse. Not to worry. There’s that $8 billion to throw to insurance companies like we’re feeding pigeons—until the bag is empty, which will happen very quickly. Then the person in question will be up a creek without a paddle. Maybe their surviving spouse will qualify for the one-time $255 Social Security lump sum death payment. Hey, cutting taxes for the rich isn’t free.
The “replace” part of “repeal and replace” is presently nothing more than a short-term patch to protect republicans from the backlash at the polls that would set in immediately if the repeal part went into effect immediately. Without that cover, who’s to blame for what would be too apparent.
It won’t work. Democrats will make sure people remember.
I just love it. Obamacare nearly totally destroyed health care in the country and the Dumbocraps love it. Now that it’s being repealed and being replaced by something that may help people, and the dumbocraps are in a lather. They don’t know if their butts were bored or punched.
you’re talking about Obozocare.
why do you say: Maybe?
That’s the problem, everybody ‘remembers’, that’s why Obozocare is now bye, bye. If you can explain the logic of making men have maternity insurance until they reach the age of 65, then we will all understand how Obozocare was the big fraud heaped upon us all. That’s even worse than requiring women to have maternity insurance until 65.
Yeah, sure I am.
Who Wins and Who Loses in the Latest G.O.P. Health Care Bill
It will be interesting if this makes it through the Senate, when the reality of what it actually means hits the average republican voter in their own households. Maybe you’re intending to stay under 64 years old, and won’t have to worry that your insurance company could charge you 5 times as much as a younger person, based on age alone. Maybe you aren’t concerned that your state will be able to waive minimum coverage standards for your policy, and will be likely to do so when money gets tight and the $8 billion sack of pigeon food runs out. They can also waive pre-existing condition protections.
A few minutes ago (MAY 24, 2017)
C.B.O. Projects Dismantling Obamacare Increases Uninsured by 23 Million in a Decade
So, maybe it’s time to begin addressing problems with the Affordable Care Act by figuring out how to fix them? Just a suggestion, mind you.
But wait, Botox Nancy and Chuck the Schmuck said that Obamacare was going to fix everything they told us was wrong with healthcare in America (not that those two idiots would know). Are you saying they lied to us? Are you saying that it is now left up to Republicans to fix the problems Obamacare created?
The Affordable Care Act wasn’t created to mess up a trouble-free healthcare system. It was a comprehensive response to a host of serious problems that were getting steadily worse and were being totally ignored.
It’s absurd to think any legislation so complex would be perfect from the start. Such things require continuous adjustment and change as problems become apparent. Instead, we’ve had continuous efforts on the part of republicans to assure the entire effort fails, when they clearly have no better solutions of their own to offer.
They’ve got control of the House, the Senate, and the White House. They got there because they assured people they had solutions ready to roll. They’ve created their own political dilemma.
No, it was created, behind closed doors, to be a major step toward the Democrats (i.e. Socialists) dream of governmental health care.
Except the left is just too stupid to understand that health care insurance doesn’t equate to health care availability.
But that is the way it was sold. Are you admitting that Botox Nancy and Chuck the Schmuck lied?
You mean like the problem of skyrocketing premium/deductible costs?
Oh, Gullible Greggie, Obamacare did not need the help of Republicans to fail. It failed under its own weight.
Yep, for less than five whole months.
Well, after all, you are the one saying problems take time to rectify. It took the Dems 8 years to screw it up. You are expecting the Republicans to clean up an 8 year Dem mess in less than five whole months.
Well, the way I see it, since you pointed out the Republicans hold both Houses and the White House, it ain’t the Republicans that is suffering from a political dilemma.
@Greg: Since when does the CBO deal with the reality of the world?