Republican Health-Care Policy: Trial and Error
The Republicans are trying to assemble a health-care bill the way some people play Words With Friends. “Is ‘raitch’ a word? How about ‘taitch’? Okay, let’s try my ‘z’ in that slot.…” House Republicans are trying anything to see whether they can actually secure the 216 votes needed to clear the House and move a bill to the Senate, where it will be someone else’s problem at least for a while.
As in Words With Friends, however, the activity quickly loses any connection with hard-won knowledge and keen analysis. You lose sight of the goal, and start just trying to jam in anything the system will accept.
The current plan is apparently not to get rid of “Essential Health Benefits,” (a big talking point for the conservative part of the coalition), but instead to use waivers that would give states broad latitude to pare them back, if they wanted to. (Very sick people, whose insurance bills might spike under this scenario, are to be taken care of via “high-risk pools,” a remedy which liberals say is inadequate, because premiums in those pools can be quite high if they’re underfunded.)
This is no way to build a health-care plan. To be fair, it is certainly the approach encouraged by the legislative system. Obamacare had plenty of its own silly deals that could be justified only on the unlovely grounds that they were necessary to secure votes for the program. And the public option, for which the left lobbied hard, was left out to get moderates on board.
However, there is a difference, which is that those things were not core to Obamacare’s design; they were peripheral issues, usually small ones. (No, the public option was not core, and would not have prevented the problems that beset the Obamacare exchanges.) Republicans are now ripping apart a program that was designed to work as a (barely) coherent whole, and trying to reassemble some of the pieces, pasting them together with other bits that various coalition members find aesthetically pleasing. The result will be … well, about the same as you’d get if you tried to do this to the engine of your car.
I understand the tight spot Republicans are in. Voter demands on health care are completely incoherent; they want the best possible health care at a very low price, and they are convinced that someone out there can give it to them but won’t because of corrupt special interests. They are also determined that not one benefit they currently enjoy should be modified, altered, mutilated, folded or spindled in any way. And they don’t want their taxes to go up, though maybe it’s okay if some very rich person they’ve never met has to pay more.
Politically, Republicans had no choice but to promise them something -- as they did, repeatedly, knowing full well that Obama would veto anything they suggested. But now that it’s time to make good on the promises, Republicans are discovering what Democrats knew: It’s a lot easier to sell your wonderful imaginary plan than one that actually has to be scored by the Congressional Budget Office and voted into existence by an ideologically divided legislature.
But health care is one-sixth of our economy. When you’re dealing with such an important sector, it’s irresponsible to let the reform process be driven more by political logrolling than by practical impact. To be clear, I don’t think that getting rid of essential health benefits is, in and of itself, necessarily disastrous for the health-care system. But it is a symptom of the piecemeal way this process has unfolded -- without a clear overall philosophy of what Republicans are aiming for, without a consensus on what such solutions should look like, and with no coherent framework for the plan that is supposed to replace Obamacare. Without those things, we’re likely to get a politically decorative engine that will stall out immediately, and leave us in a worse mess than Obamacare did.
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