Republicans in Congress have created their own internal gridlock on ObamaCare. Even if the Democrats all abstained and let Republican legislators do whatever they wanted, the Republicans still could not agree on what to do next.
From the base there is the incessant cry for repeal. But as just about every Republican candidate in this last election acknowledged, there can be no repeal without replace. Otherwise, from 10 to 15 million people will lose their health insurance. However, repeal and replace means transitioning from ObamaCare to a new system. And no matter how radically different the new system is, it will run the risk of being called ObamaCare lite.
In fact, there isnt a single Republican replacement plan that hasnt already been called ObamaCare lite. And thats before any negotiation with the other side takes place. Any repeal and replace agreement that has been negotiated with Democrats in Congress and with the White House will almost certainly be viewed with suspicious mistrust by the Republican rank and file.
Fortunately, there is a way out. In going forward, the GOP needs to make clear to its own base and to the Democrats that in any negotiation they will follow five simple rules.
Rule 1: No deviation from a simple vision. The Republican objective for the voting public should be: Keep your job; keep your health insurance; and keep your doctor. The most direct way to get rid of all the anti-job provisions of ObamaCare is to repeal the employer mandate. The most direct way to insure that people can keep insurance they like is to repeal the individual mandate. And the most direct way of insuring people can keep their doctor is to deregulate and denationalize the health insurance exchanges.
Rule 2: No backsliding. Negotiators rarely get everything they want. And whatever they get, Republican negotiators will be vulnerable to the charge that they are helping ObamaCare work better. So here is the answer to that. Anything that leads to more job losses, more loss of insurance people want and more loss of doctors is off the table before anyone even enters the negotiating room. That is the line Republicans must not cross. Making health reform work better is okay so long as it moves us in the direction of the vision in Rule 1.
Rule 3: No separate deals for special interests. The reason ObamaCare looks like a Rube Goldberg contraption is because it is almost purely the product of special interest bargaining. There are no principles like justice or fairness that guide its content. Now that the impure deed has been done, however, we find that every single interest group wants to renege on its share of the burden.
Should we have a medical device tax? Probably not. Should labor union plans be taxed to subsidize health insurance for their non-union competitors? Absolutely not. Should hospitals have their charity care money restored? If we dont we are going to be in serious trouble.
But remember why all those provisions are in the law. Special interests went behind closed doors and sold the rest of us out. Now they want to be relieved unilaterally from what they originally agreed to throw into the pot. That shouldnt be allowed. They cooperated to give us mess that we are in, we need them now to cooperate to get us out of it.
So, nobody gets relief from ObamaCare without helping and supporting the overall effort to reform it.
Rule 4: No provisions that produce pain with no gain. It is tempting for Republicans to try to block the system in place that subsidizes health insurance companies that are participating in the exchanges. These are provisions that protect the insurance companies against unexpected losses for the next three years. Some of the subsidies come from redistribution among the insurers themselves. But there is also an (apparently unlimited) taxpayer liability. Do you know anyone who wants to pay taxes to subsidize insurance companies? I dont.
The problem is, this very same system of transition was adopted for Medicate Part D drug program by a Republican administration. And when Republicans were doing it, other Republicans didnt complain.
Rule 5: No taking of political advantage, no matter how tempting. Yes, I know. The other side deserves all the political backlash it is getting. Had Barack Obama endorsed Sen. John McCains (R-Ariz.) health plan, we would have had a better reform, a more workable reform and a more progressive reform than we now have.
But Democrats have already paid a heavy political price for that mistake. Voters elected Republicans this last time around because they want to move on.
|John C. Goodman is a Senior Fellow at the Independent Institute, President of the Goodman Institute for Public Policy Research, and author of the widely acclaimed Independent books, A Better Choice: Healthcare Solutions for America, and the award-winning, Priceless: Curing the Healthcare Crisis. The Wall Street Journal and the National Journal, among other media, have called him the Father of Health Savings Accounts.|
Obamacare remains highly controversial and faces ongoing legal and political challenges. Polls show that by a large margin Americans remain opposed to the healthcare law and seek to repeal and replace it. However, the question is: Replace it with what?