Republican leaders are trying to line up votes for another Obamacare repeal bill, with a vote possibly coming later this week. It’s also possible the new repeal effort will collapse, sending legislators back to the drawing board. Here are some principles to keep in mind, based on what Republicans have been saying to their constituents since 2010, and what happened when they made their first run at repeal in 2017.
Take your time: Congressional Republicans and the White House have already paid the political price for the failure of their first repeal effort. They bought themselves time, which they should invest wisely. Granted, something needs to be done before the insurance industry implodes completely, but there is enough time to craft a good bill.
It’s also important to take the time needed to sell the bill, to both legislators and their constituents. President Obama put a great deal of effort behind the politics of pushing Obamacare through. He lost interest in managing the program after it passed, leading to the inexcusable launch debacle, but no one can fault him for a lack of hard work and careful preparation in guiding the Affordable Care Act through Congress.
The American people should be brought on board with a combination of fearless, trenchant criticism of Obamacare plus touting the benefits of the repeal bill. The previous effort had all the energy and enthusiasm of a petulant child reluctantly taking his medicine. Sure, everything Obama and his cronies said about the Affordable Care Act in 2009 and 2010 was a lie, but they lied with vigor and conviction.
Conservatives mock Big Government leftists for their arrogance, and for appalling results that make a mockery of their unjustified sense of superiority, but one should never underestimate the appeal of the moral conviction that animates the Left. They’re absolutely convinced they are doing the right thing – they will occasionally dip a toe into religious rhetoric and claim they’re doing the Lord’s work – and anyone who opposes them is a monster.
Conversely, congressional Republicans and the Trump White House displayed no air of conviction during the first Obamacare repeal debacle. They acted like they were checking off a box on a to-do list. They looked insincere. It brought the party some much-deserved ribbing for never being serious about its copious promises to repeal Obamacare over the ears, or the many phony bills they sacrificed to Obama’s veto pen.
Time and political effort are needed to lay the groundwork for a repeal bill the public will take seriously. Democrats will act like crusading heroes trying to prevent the selfish Republicans from killing poor people by taking away their health care. Conviction and moral preening will come easily to the other side. If Republicans can’t muster a comparable level of moral authority, they might as well skip a political battle they are destined to lose.
Part of the price paid for the hasty initial effort to repeal Obamacare was a significant slide in GOP poll numbers on health care; a slide helped along by left-wing theatrics at town hall meetings. Efforts by political action groups to pressure Republican legislators into climbing back aboard the repeal train are misguided. Pressure the Democrats, make recalcitrant Republicans feel like this is a fight they can win, and they’ll get back on board.
Promote the free market and attack collectivism: One of the big problems with that first doomed effort is that it conceded too many vital arguments about health insurance reform to the Democrats. The most crucial of these arguments is the false belief that insurance (and medicine itself) cannot be entrusted to the free market.
This contention is the gateway on the road that leads inexorably to the eternal hell of single-payer nationalized medicine. Most Republicans love to talk about the superior efficiency of the free market at allocating resources, and the moral superiority of free capitalist choices over collectivist solutions imposed by force. Sadly, that conviction tends to evaporate when leftists start yelling about how conservatives enjoy killing people by taking away their “free” benefits.
Conceding the point that free-market capitalism is cruel and mercilessly exploitative is dangerous, and will presage the loss of much more than the freedom to buy decent insurance at reasonable prices. The Left uses healthcare as its wedge issue to indict freedom as cruelty because it knows people have strong emotional responses to the prospect of poor and sick people “left to die.” It knows the public believes everyone involved in medicine and health insurance is making obscene profits. It knows few voters truly understand medical science. They’re understandably afraid of getting sick, and they find the huge and complex medical industry incomprehensible. They don’t understand why a tiny little pill, or half an hour of a doctor’s time, has to cost so much.
The crucial weakness of healthcare capitalism, exploited relentlessly by the Left, is that people don’t view medicine as a commodity. They think it should be immune to the laws of supply and demand because everyone needs it. Paying for medical treatment is not celebrated as scoring a hot deal for a great product, the way people think of purchasing retail goods, even really expensive items like houses and cars. Buying medicine feels more like losing a bet, getting penalized, adding the insult of medical bills to the injury of sickness.
People have been persuaded not to view health insurance as a commodity, either. No one really enjoys “shopping for a good deal” in health insurance, because they don’t understand the complexities of the industry, let alone the complexities of the medical treatment paid for by insurance plans. (It’s interesting that the Affordable Care Act hucksters felt the need to weave capitalist language about freedom of choice and a positive Obamacare “shopping” experience into their pitch, risibly comparing the ACA web exchanges to shopping at Amazon.com. They know it’s important to flatter Americans’ vestigial appreciation for free markets, even as they plot to subvert and destroy them.)
One of the most effective arguments against those who insist healthcare is a “right” that should be provided for “free” or at heavily subsidized prices by the State, is to ask them why the even more universally essential need for food should not be satisfied the same way. They never have a good answer for why food shouldn’t be provided by the government, even though most people need food even more urgently than medicine or health insurance. The reason for their silence is the lingering left-wing fear that voters know exactly what happens when governments handle food distribution. Nobody wants to schlep to a grim State-run food dispensary to wander among bare shelves with ration card in hand.
And yet, that’s precisely what is happening to health insurance under Obamacare. We didn’t get a rainbow of choices between competitive plans at great prices. We’ve got insurers bailing out of the market left and right, leaving effective monopolies in some areas. Prices are way up, and quality is down. Only lavish subsidies hide the real price of Obamacare insurance plans… turning middle-class Americans into welfare dependents in the process.
Fight for capitalism and free markets, Republicans. Show people that you truly understand and believe in their power and righteousness. Healthcare and insurance were ripened for takeover by decades of Big Government meddling to drive up prices, separating buyers from providers with layers of bureaucracy. Reverse that process, let honest competition bring prices down for everyone, and then make reasonable accommodations for the small number of truly needy customers who cannot afford even those low prices.
Shift the political center of gravity: Ever since the Tea Party wave election in 2010, pundits have debated the political wisdom of Obamacare. Democrats paid an enormous political price in 2010, 2014, and arguably 2016 for passing the bill, but they also got something in return for that price. It was no small achievement: they might have changed the relationship between American citizens and their government forever.
Obamacare extended government control over a major sector of the U.S. economy, gobbling up student loans along the way. As noted above, it has turned a vast swath of the middle class into welfare dependents, which gives the Party of the State future leverage over their votes. The loss of essential insurance subsidies can and will be used as a threat against voters who dare to call for smaller government. The first dollar of spending cuts will be portrayed as coming out of insurance subsidies, much as we currently hear that the first dollar of spending cuts means cops, teachers, firefighters, and paramedics will get pink slips.
Obamacare is the largest single step the Left has ever taken towards its dream of total control over medicine, forever. Countries with socialized health care tend not to have significant “conservative” parties, in any sense Americans of 2008 or earlier would recognize. When the State controls the very health of its citizens, nationalizing the vast amount of money and authority represented by the medical community, it no longer has any reason to fear the wrath of those citizens.
We’re getting a taste of that right now with the Obamacare repeal drama. The Affordable Care Act may have been unpopular throughout its life, but it commands more than enough money and influence to defend itself.
Was all of that worth Democrats losing the House and Senate for a few years, especially when the Republican majorities were mostly occupied with trying to slow Barack Obama’s roll? Was it worth the surprising loss of the White House to Donald Trump? If the Republicans still can’t repeal the ACA even with the House, Senate, and White House, the price that will be extracted from them by angry and dismayed GOP voters will offset some of the Democrats’ losses.
The Democrats lost their entire moderate-centrist wing under Obama, dragging the party far to the Left. It’s much too early to judge whether that was a bug in the Obamacare program, or a feature, especially since they dragged a good deal of the electorate to the Left in their wake. They reasonably hope they moved the “Overton window of political possibility” permanently, while their electoral setbacks will eventually be reversed.
Democrats did something big with Obamacare and paid a big price. That’s a strategy likely to achieve long-term success against opponents who only pay small prices to accomplish small things. This is not just a policy argument, but a clash of philosophies. If the GOP tinkers with a few policy details while leaving the core philosophy behind Obamacare intact, any victory they might claim will prove to be short-lived.
Don’t become accomplices to Obamacare: Ever since the passage of the Affordable Care Act, Democrats have been desperate to get some Republican fingerprints on it. They love to complain about Republican resistance to the Obama agenda as the driving force behind Obamacare’s failure, but that’s a smokescreen to distract the American people from the cold, hard truth that it’s a 100 percent Democrat program. If Republicans cave into Democrat pressure to “fix” the Affordable Care Act, they will instantly become full partners in its failure.
Contrary to what some of the squishier Republicans might be thinking, that will not make Democrats less likely to blame them for everything that goes wrong with health care. Quite the reverse. Future political campaigns will be fought over which party is a better steward for the government-run corporatist health insurance industry that both parties ratified. Republicans are not likely to win that argument, and they’ll have a hard time resisting Democrat pressure to expand the system they signed on to.
Don’t be intimidated by factoids about people “losing insurance”: When Barack Obama told the biggest lie in modern political history – “If you like your plan, you can keep your plan” – his primary goal was to falsely portray the Affordable Care Act as a voluntary program. He boasted the program would be such a huge success that Americans would voluntarily abandon their old-fashioned pre-Obamacare plans and buy his plans instead. He promised better quality at lower prices.
Obama’s big fib had a secondary purpose – he needed to conceal how many people would lose their insurance under his plan. Millions of people lost their insurance plans because of the Affordable Care Act. Quite a few people have lost more than one insurance plan because of Obamacare-related disruptions to the market since 2010.
The total number of lost plans is hotly debated, but it surely compares to phony Democrat talking points about how many Americans would supposedly lose coverage under current repeal proposals. It’s not reasonable to assume that all of those losses would be catastrophic and permanent, any more than it is reasonable to say Obamacare’s destroyed insurance plans don’t count at all because most of those people eventually found other coverage.
Democrats claim the number of people who lost insurance under the Affordable Care Act is irrelevant because most of them ended up buying new (and very often worse) plans to replace their lost coverage. Senator Ted Cruz (R-TX) once compared this to vandals smashing windows, offering to sell replacement windows to their victims, and bragging about the high volume of window sales under their business model.
The same is true of any Obamacare repeal proposal – most of the people who “lose” insurance will obtain new plans, and if the free market is allowed to function properly, those plans will be cheaper and better. Republicans should always and everywhere push back against the false narrative that insurance lost under Obamacare doesn’t count because most of the losses were temporary, but only insurance that might be lost under repeal proposals counts, and all of those losses must be treated as permanent.
If that ridiculous argument isn’t killed during the Obamacare repeal debate, reformers will face a new version of it every time they attempt to scale back any government program. It’s a key element of the “progressive” strategy to ensure that ground seized by the State is never returned to the people.
Another aspect of that strategy is the notion that only benefits provided or subsidized by the government really count. Expecting people to pay for their own stuff is tantamount to “denying them access” to whatever progressives think they have a “right” to. This new ideological weapon was rolled out in a big way during the 2012 presidential campaign, but many Republicans seem to have missed its significance or dismissed the “paying for my own contraceptives = oppression” argument as too silly to merit a response.
They were wrong, and if they don’t persuade voters to resume viewing health insurance as a market commodity instead of a “right” that should be administered by the sacred temples of the holy State, they’re going to have a hard time restoring what the Obama Democrats took away from the private sector.
Bring back cost/benefit analysis: Politicians are eternally at war with two key economic concepts: the law of supply and demand, and cost/benefit analysis. In their daily lives, people understand that costs are important, even when a particular good or service is highly desirable. Politicians specialize in making them forget such common sense, stampeding voters into agreeing that certain goals are so righteous or urgent that cost is irrelevant. Those who ask hard questions about the cost or wastefulness of sacred government programs are denounced as heartless penny pinchers.
It matters very much that Obamacare is absurdly expensive and wasteful. That’s real money being siphoned from our productive private economy and thrown around by the bureaucracy. A repeal plan that saves American taxpayers billions of dollars is a good thing and should be promoted to the people who pay all those taxes, insurance premiums, and deductibles as such.
During the previous Obamacare repeal effort, the Congressional Budget Office said the repeal bill would increase the number of people without health insurance by 24 million while saving $337 billion. Cries of “24 million people will lose insurance under the GOP plan!” were highly dishonest – that’s not actually what CBO said – but just for the sake of argument, divide $337 billion by 24 million people and you come up with over $14,000 a head. That doesn’t speak well of Obamacare’s cost efficiency, does it?
The amount paid per individual “helped” by the Affordable Care Act is ludicrous. Republicans should never tire of pointing that out. Using the free market to make insurance and medicine more affordable for everyone, and then spending more modest sums to help the needy obtain those reasonably priced goods, is far more efficient than a bloated, ham-fisted government control scheme, and it’s far more respectful of our money and freedom to boot.
Attack the core rationales of Obamacare: Speaking of cost/benefit analysis, one of the core rationales for the Affordable Care Act – almost the only convincing point in its favor, for many average Americans – was the argument that uninsured people still receive health care for free at hospitals, because they are not allowed to turn sick people away. The rest of us were supposedly paying an exorbitant cost for this “cost-shifting” through taxes and higher insurance premiums. Imposing a government regulatory scheme that forces everyone to buy insurance makes sense to many non-ideological Americans, at least in theory. The Obama White House described cost-shifting as a “hidden tax” of at least $1,000 a year on every American insurance customer. How else could we possibly alleviate the cost-shifting crisis, without tossing uninsured sick people onto the streets?
Versions of this argument are heard to this very day, even though Obamacare supposedly “fixed” the cost-shifting problem – that was one of its primary objectives, along with ensuring access to insurance for people with pre-existing conditions, who are guaranteed money-losers that callous insurance companies would rather not cover at reasonable prices.
Neither one of those core issues was remotely as serious as Democrats made them out to be, and Obamacare is not the optimal means of addressing either. This is partly a matter of cost/benefit analysis: total up the time and money spent on Obamacare compliance, divide by the number of people who were truly ill-served by pre-ACA insurance, and you could afford to not only cover those peoples’ insurance needs but buy each one of them a late-model car.
Research produced late in the Obamacare debate showed that cost-shifting was never as big of a problem as we were led to believe – certainly not a $1,000 secret tax, or a problem big enough to justify the costs in dollars and liberty imposed by the Affordable Care Act. It was easy for Democrats to exaggerate the size of the problem because the insurance industry and its lobbyists have always pushed cost-shifting mythology as a convenient excuse for high insurance premiums. Everyone involved in dumping Obamacare on us knew cost-shifting was a seemingly logical argument they could sell to a vast number of moderate voters. It was even invoked as an argument in favor of preserving the individual mandate before the Supreme Court.
There are much less expensive and intrusive ways we could address the problem – and frankly, Obamacare isn’t really addressing it, because reports from the Obama Administration itself found uninsured visits to hospital emergency rooms had scarcely been reduced at all. One of the big reasons for that is something Democrats are extremely reluctant to talk about: a great deal of the cost-shifting burden comes from illegal immigrants. Another reason is that even people who have insurance will rush to the emergency room instead of waiting for their insurance-designated doctors to become available.
Republicans should mercilessly hammer the fact that Obamacare did very little to address one of the key arguments presented in its favor. Also, zero in on the fact that much of the “increased coverage” provided by Obamacare is really coming from Medicaid, and speak fearlessly about the problems facing that program – from fiscal crises to the poor access to doctors it offers many enrollees. Point out that if Democrats wanted to radically expand Medicaid, they should have honestly discussed it with the American people in 2009 and 2010, rather than hiding behind the smokescreen of private insurance reform.
Covering people with pre-existing conditions is a much more complicated issue. Again, it’s popular with Americans because they think it just doesn’t make sense to leave people with serious health conditions without access to affordable insurance – even though selling coverage to people who are guaranteed to generate more costs than income doesn’t really fit the logical definition of “insurance.”
Be honest with the American people: We ought to be more focused on securing affordable health care for patients with pre-existing conditions, instead of cramming them into the same market that sells bona fide “insurance” against the risk of illness and injury to healthy customers. Forcing insurance companies to cover the cost of care for customers with existing conditions, and allowing them to recoup those costs through a mixture of taxpayer subsidies and higher premiums for everyone else, is a far more serious “cost-shifting” problem than the one employed as a sales pitch for Obamacare.
Republican reformers should stress the need for more honesty in our opaque and confusing medical and insurance systems, which became even more opaque under Obama’s plan. The true costs of medicine are more obscure than ever to average consumers, and the network of shifted and hidden costs to cover them is more complex. Be honest about the needs of people with pre-existing conditions, and healthy people who can’t afford even the inexpensive coverage that true market competition will provide.
Present the taxpayers with a clean, understandable invoice for handling the needs of those people, in the most streamlined and efficient manner possible, with the lowest bureaucratic overhead. Don’t fumble around with schemes to give them “insurance” – worry about the medical care they need, and how our society can best provide it. Let the cost be spread thin, fair, and clear among us all.
We’ll pay it. If there’s one thing polls have proven beyond question, it’s that Americans do not want sick people to lack adequate care, or be financially ruined by paying for it. The political class needs to stop dreaming up elegant schemes to pick our pockets and line the pockets of their cronies. Just give us an honest, efficient plan to do what the American people have clearly stated they want to do.
Don’t be afraid to take a few hits: Those who cringe at the first sign of a raised fist rarely win fights. The previous repeal effort would have given us Obamacare Lite, and yet its authors and supporters were still excoriated as inhuman monsters by the Left, their modest restructuring of the Affordable Care Act depicted as a plot to murder the poor.
This should serve as yet another lesson – why are any more needed? – that no matter what Republicans do, they’ll be hit with a cyclone of hysterical emotion-based attacks by the Left, especially in the current hyperventilating “Resistance” political environment.
That means even the smallest reform will carry much the same political price as a major overhaul. So why not swing for the fences and do something truly meaningful? Why shouldn’t the GOP focus on giving its voters what they want, instead of worrying about tantrums from the people who lost the last election? Why make deals to appease an opposition that cannot be appeased?
Republican strategists should be able to learn a lot by studying the last repeal battle. It should be easy to anticipate Democrat and media lines of attack against a bold repeal plan. Be ready for those attacks with sharp responses, focused on selling the GOP plan to voters who clearly believe Obamacare isn’t the best way to handle health insurance. Be prepared to shoot down misleading factoids and relentlessly hammer everything people don’t like about the post-ACA insurance landscape.
Repetition is your friend, Republicans – look at how relentlessly Democrats jackhammered away at every weak spot in the health care system when they were laying the groundwork for passing the Affordable Care Act. (Of course, they were well prepared for the effort because many of those weaknesses were deliberately created by government regulations over a span of decades – the Left was hitting weak spots it had long ago created.)
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