“Repeal and Replace” Becomes Retain With Disgrace
Candidate Trump last year pledged repeatedly to “repeal and replace” the misnamed, choice-suffocating, jobs-killing, premium-boosting Affordable Care Act (the ACA, or “ObamaCare”). Republican Senate Majority leader McConnell and Republican House Speaker Ryan promised the same thing, many times.
In the five months since Mr. Trump’s election the GOP has had plenty of time to prepare for what it promised; in fact, it had already crafted many plans in the years since 2010 when the ACA was enacted. But late last week, after working for a mere 18 days on ineffectual half-way measures, and insisting on a complex, multi-step strategy, Mr. Trump, Mr. Ryan and the GOP leadership blithely dropped the whole thing, whining that they had insufficient votes and implying that they needed to win still more seats. In truth, a large majority of the GOP does not oppose the ACA; many of them fear the costs of possible repeal more than they value the benefits.
The deeper problem is that too many leaders have come to believe that health care is a “right,” meaning it should be made available coercively, without people voluntarily and fully paying for it – the premise which, historically, has ruined entire sectors and economies. Think of the crash of 2008-2009 due to years of policies based on the premise that everyone should own a home, especially those who can’t afford it.
To enact the ACA in 2010, the Democrats worked unilaterally and persistently for 14 long months, amid loud public opposition. They were principled, patient, and pushy – brazenly refusing to seek (or obtain) a single GOP vote. Of course, the Dem’s principles were dead wrong (socialist), but at least they posessed the confidence and willingness to exercise the political power they’d earned.
Now the GOP has all the power – hence, no excuse for its utter failure to deliver on its promise to repeal and replace the ACA. Especially vicious is the claim of Mr. Trump (and other GOP leaders) that the failure was caused by a 30-member Freedom Caucus – Republicans whose genuine belief in the GOP’s pledge to repeal and replace led them properly to reject the futile half-way approach.
The real culprits behind last week’s failure are the 50 members of the “moderate” GOP “Tuesday Group”– the group that was formed by those who, in the wake of the GOP’s 1994 takeover of the House, were politically to the left of President Clinton and opposed his view that “the era of big government is over.”
For Mr. Trump, the era of big government has only just begun. Yesterday, he “tweeted” that “the Freedom Caucus will hurt the entire Republican agenda if they don’t get on the team, and fast. We must fight them and the Democrats in 2018!” That says it all. Mr. Trump now pledges to fight against those Congressmen who are the most pro-capitalist, claiming they’re akin to the Democrats who’ve loved the ACA all along. The man who says he’s the world’s best deal-maker now pleads political impotence and insists that 30 out of 535 legislators can “hurt the entire Republican agenda.”
In truth, the Freedom Caucus had relaxed its hope for a complete repeal of the ACA and had asked only that Mr. Ryan drop some of the ACA mandates on coverage per se and on types of coverage (like the “essential benefits” mandate, that people must buy coverage they don’t need). The Freedom Caucus also asked to drop the egalitarian, anti-insurance principle of “community rating” – the ACA’s price-equalization scheme that forbids insurers from charging differential premiums for behaviors clearly differentiated by risk. Under the ACA, insurers can neither charge higher premiums for reckless drivers, the obese, or smokers; nor can they charge lower premiums for those who avoid such behaviors. Mr. Ryan wouldn’t relent; he preferred keeping all of this in his alleged “new” bill.
The ACA is an abominably unjust, anti-prosperity law that consigns America to the doorstep of socialized medicine – the system that has proved ruinous to health care suppliers (insurers, drug makers, hospitals, and doctors) at all times and in every country where it’s been adopted. And, as history also proves, once the producers of any set of goods and services are dispossessed and dis-incentivized, it’s never long before the harm extends to consumers – to the “unfortunates” whom the socialists had claimed would be helped.
The ACA was an inevitable outgrowth of the equally anti-capitalist Medicare and Medicaid programs launched in 1965. Now insolvent, those programs have imposed the suffocating regulations, taxes, and paperwork that have driven waves of great doctors and providers to retire prematurely or quit outright.
If the ACA isn’t repealed and replaced by a free market system, and if Medicare and Medicaid themselves are not scaled back and phased out, massive losses for private health care providers are inevitable – in turn, further reducing the range, quality and affordability of health care for greater numbers of consumers.
The wake of those losses will bring the rise of a “single payer” system – i.e., a stultifying, exploitative state monopoly – first over payments, then over all aspects of medicine. Increasingly, America’s medical sector will exhibit the efficiency of the Post Office, the service of the DMV, and the compassion of the IRS.