Wednesday, March 8, 2017


There’s been a lot of histrionics over the first draft of the Obamacare repeal-and-replace bill. Everyone should take a deep breath to prevent a Republicans intraparty knife fight, which would play into the waiting hands of Chuck Schumer and Nancy Pelosi.

But the operative word to remember is “draft.” This is a first draft and some of the biggest problems that conservatives, like Rand Paul and Mike Lee, have identified must and can be fixed. What we’re learning is that the Republicans are united to repeal Obamacare, but there’s nothing close to consensus about what to replace it with. Republicans don’t do health care well. If they did, George W. Bush would have reformed the health care system and no one would have suffered Obamacare.

At issue now is whether it’s sufficient to repeal Obamacare and revert to the status quo ante, which was flawed to begin with, given the runaway costs of health care. Paul Ryan and Rand Paul want separately to reform the entire health insurance market and both have good ideas about how to do that.

But the order of the day is to repeal a very bad and unpopular law that Barack Obama foist on Americans seven years ago. Congress can’t take its eye off the ball: In every way — controlling government costs, allowing customers to keep their doctor and insurance, saving Americans money (remember the promised $2,500 lower costs per family) — Obamacare is universally recognized as a flop. By fighting first over what to replace Obamacare with, the crucial focus has been lost, and the public risks thinking the devil they know is preferable to the devil they don’t.

The only “victory” of Obamacare is that it covers more Americans, almost entirely by expanding Medicaid, which is one of the least workable and most expensive excuses for a health insurance system anywhere. Democrats are playing a persuasive argument, that poor people will lose their insurance under the Republican plan. It does in fact make sense that Americans who bought insurance under Obamacare must keep their coverage for the next two years or so.

The rest of Obamacare should be eviscerated. The employer mandates must be gone. The mandated benefit package must be gone. The tax increases must be gone. The community rating, which has perverted the insurance market and sent costs through the roof, must be gone.

Enabling customers to buy insurance across state lines, and medical malpractice reform (of which there isn’t much in the Ryan draft bill) are imperative. The objections by conservatives that the Ryan bill creates a “new entitlement” may be exaggerated. The bill’s refundable tax credits aren’t really an entitlement, and they’re far superior to the network of inefficient subsidies and mandates in Obamacare. A tax credit, which is something like a health care voucher, enables customers to shop around, which will encourage creation of a patient responsive, competitive market.

Conservatives are right to insist on further expansions of health savings accounts, which will make everyone more cost-conscious consumers of health insurance. But repeal of Obamacare is the first order, and failure to do so would be catastrophic, both for the party and for the conservative movement. The best market-driven health care reform bill that can get 218 votes in the House and 50 in the Senate is the first goal. Conservatives must insist that the second “draft” is much improved, and if they grind Obamacare to a halt it will be the victory they promised, and the deserved mortal blow to the legacy, so called, of Barack Obama.

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