The future of health care: bigger than a bread box?

Photographer: Alex Wong/Getty Images

The Guessing Games Republicans Play on Health Care

Megan McArdle is a Bloomberg View columnist. She wrote for the Daily Beast, Newsweek, the Atlantic and the Economist and founded the blog Asymmetrical Information. She is the author of "“The Up Side of Down: Why Failing Well Is the Key to Success.”
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Tea-leaf readers, stop straining those prophetic eyeballs: The future of Republican health-care policy will be just as clear if you stare into a random pile of vegetable matter.

Trump is a cipher, having clearly never given the matter much thought himself; congressional Republicans want to repeal Obamacare to please their base, but somehow do it without upsetting the people who will thereby lose coverage. In between them is the nominee for secretary of Health and Human Services, Tom Price, a man of firm convictions, but unclear mandate to enact his ideas.

We might have hoped to get some sense of where things are headed from Wednesday’s Senate hearing on Price’s confirmation. We might also have hoped to get a bow-wrapped Lexus in the driveway this Christmas, but most of us probably didn’t.

Senate confirmation hearings are always more ritual than substance. The party of the nominee asks penetrating questions such as “Isn’t it true, Madam, that you once rescued an entire family of orphans from a burning building?”, with frequent pauses to thank the nominee for being there, and perhaps compliment them on their taste in confirmation hearing attire (confident, but understated, you understand). The opposition ranges from feigning outrage about things they have done themselves, to petulant whines about how much time they are being given to probe the vital matter of the parking ticket the nominee received in 1984 for depositing their car in a snowplow zone.

But the ritual is necessary. It allows us to maintain the polite fiction that our legislators actually care what the nominee thinks, rather than the partisan impact of confirming them. It can inform the public about issues with the nominee’s record that they should care about, even if they don’t. And occasionally, mostly by accident, actual new information does get tossed out.

Alas, this was not one of those times when we gather new information. Price is a seasoned politician, and seasoned politicians are very good at concealing what they actually think from the public, if that thinking is politically inconvenient. (Even Donald Trump, whose brain-to-mouth filter seems to have been fatally damaged sometime back in the 1970s, hews to this rule -- by having no firm political opinions to slip out.) The hearing consisted primarily of Republicans asking Price to elucidate -- or elaborating for him -- just what a swell fellow Tom Price is, and how gosh-darn much he cares about sick people. And Democrats asking three types of questions:

  1. Pointed interrogation about some stock trades which certainly look … less-than-salubrious, even if they were not illegal.
  2. Silly questions about irrelevancies, such as Price’s past ownership of tobacco stocks.
  3. Attempts to pin Price down as to what, exactly, he might do with Obamacare.

The first line of questioning is completely fair; ethics matter. On the other hand, in the current case, they don’t matter much. It seems unlikely that a public that elected Donald Trump after all the reports of his dodgy business dealings is going to turn in outrage against a congressman who doesn’t appear to have done anything illegal. Moreover, there’s a prudential consideration even for Democratic senators who are legitimately outraged: given the, let us say, variable quality of Trump’s nominations, nixing the devil they know might easily result in someone they’d much less rather have at the helm of HHS.

The silly questions are just, well, silly, and we will dispense with them. That leaves the question of what Price is going to do about Obamacare, and Price’s answer to that was, basically, “I’m excited to find out!” When pressed he pointed out, correctly, that most of the things Democrats were asking him about were matters that were going to have to be decided by Congress, in writing whatever laws they decide to pass. The HHS secretary certainly participates in that process, but their role is not necessarily as large as you might think. Kathleen Sebelius was not the most important figure in the passage of Obamacare; she probably wasn’t even the tenth-most important.

Of course, Price arguably has more scope for importance. Republicans have historically not been that interested in health-care reform, and members have fewer strong commitments to one framework or another, creating space for a strong figure to step in. Trump has even fewer firm ideas (I’m tempted to say none). Price certainly could step into that vacuum and leave a firm handprint on whatever Republicans end up doing. On the other hand, he could end up hamstrung by a boss who isn’t particularly interested in the issue, obviously doesn’t care to spend much time thinking about complex policy matters, and has a leadership style we might call “management by 3 a.m. tweet.” We don’t know how much power Price will have over the process, and I doubt he does either at this point. Which means that he wasn’t just being politically expedient when he declined to say what he would do. He, like we, will find out when Republicans take full control of the ship of state, and start deciding where they’re going to steer it.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story:
Megan McArdle at mmcardle3@bloomberg.net

To contact the editor responsible for this story:
Mike Nizza at mnizza3@bloomberg.net