The effort to replace the Affordable Care Act has apparently failed, and predictably so. It’s time to try a different approach. It’s called compromise.
The problem isn’t just that the Senate is divided; the Republicans who control it are split. Their factions include ideological conservatives who want the government out of health care entirely and practical ones who fear the consequences – political and medical – of depriving millions of Americans of access to health care. Both groups, sometimes simultaneously, have opposed replacement plans crafted by Majority Leader Mitch McConnell, blocking action on legislation whose cruelty was barely disguised.
Meanwhile, President Trump – who campaigned on a promise to provide “insurance for everybody” and not to cut Medicaid – had been pushing either for outright repeal or for the government, already having sabotaged the ACA, to do nothing and let it collapse. By Wednesday afternoon, however, he was calling on Republicans to resume working on legislation to repeal and replace Obamacare.
Whether McConnell can round up 50 votes on any proposal remains in doubt. McConnell, thwarted in every other move, had said earlier this week that he will take the repeal approach, with a promise to replace the plan in two years. But that idea began to fail almost as soon as he announced it, and just as well. If Republicans can’t replace the law now, what would be different in two years, beyond potentially destructive influence of the 2018 midterm elections?
As an evidently last resort, McConnell has “threatened” to talk with Democrats to stabilize the insurance markets and move ahead. Senate Minority Leader Charles E. Schumer is frantically waving his arms, signaling his willingness to negotiate. Why wait?
Even without the Trump administration’s machinations, it has been plain that the ACA needed to be revised. It is, as former President Barack Obama himself observed, akin to a starter home. The intention was always to improve the legislation based on actual experience.
But improving it – or, at least, making it palatable to both parties – has to begin with an understanding of the idea that a healthy population serves the national interest. It’s not the wacky concept some opponents of the ACA make it out to be.
Other things being equal, a nation where health is difficult to maintain is weaker than one where it isn’t. A case in point is the military’s concern about filling its ranks given the nation’s levels of obesity. That’s not a squishy liberal worry, but a matter of national security.
Health care also relates to children’s ability to learn and to pursue productive lives as taxpaying citizens. It means their parents are less likely to miss work when children become sick. It means lowering overall costs, by providing primary care to people who would otherwise show up in emergency rooms, where medical care is at its most expensive and typically underwritten by taxpayers.
This is a legitimate issue for the nation, and if Republicans and Democrats in Washington can get out of their own way – and the country’s – they could formulate a broadly acceptable law, as Republican Mitt Romney did in 2006 in Massachusetts when he was that state’s governor. That’s what they should do, and there are many ways to proceed.
Republicans could insist on lawsuit reform that limits punitive damages but still provides fair compensation for those who are harmed by medical errors. They should relent in their opposition to allowing the federal government to use its buying power to drive down the costs of pharmaceuticals. That’s Business 101.
Democrats, meanwhile, could push again for a version of the “public option” that was part of the original ACA plan but was dropped. It creates a pressure point to keep the costs of private plans from exploding.
Many other approaches could be considered to continue supporting private-market health care while providing coverage for those who would otherwise be uninsured. It’s complex, a fact that belatedly dawned on Trump, but it’s not impossible. It’s a matter of political will.
What Republicans should fear is any plan that deprives millions of Americans of health care coverage. That’s a political suicide note disguised as legislation – and particularly heartless legislation, at that.
Having pushed phony repeal measures for years, knowing full well that Obama would veto them, it is not surprising that Republicans are taking this approach. They feel they have something to lose by doing nothing, but making health care worse is a loser, both in terms of party politics and public policy. Republicans should cut their losses.
If they were truly interested in producing something of value, they would negotiate with Democrats with an eye to attracting enough serious members of both parties to produce a bill that Trump would be inclined to sign. If it seems unlikely, so at one time did President Trump.