I have been writing about Pres. Trump’s dysfunctional relationship with a GOP Congress almost since the beginning. When the House’s healthcare reform bill initially failed I assessed the blame on both sides. It’s true that Trump has weakened his own presidency in ways not seen in modern times.
But the more I mull it, the more I think the GOP’s problem with healthcare (health insurance) reform rests well beyond Trump or Congress. It’s really Rich Lowry‘s observation about the populists not taking themselves seriously, but broader.
Ramesh Ponnuru recently discussed seven reasons the GOP couldn’t kill Obamacare, and as usual, it’s worth it to RTWT. But it really boils down to two fundamentals: people don’t like the disruption that comes with reform and the GOP has little interest in healthcare policy at any level.
Of course, if you’re old enough, you’ve been here before. Back in 2010, HotAir’s Ed Morrissey argued that had a unified GOP government tackled healthcare reform at some point between 2001 and 2006, Obamacare might have been avoided. Patrick Ruffini similarly argued that market-based reform of healthcare costs (instead of focusing on health insurance access), would have killed the issue for Democrats.
(In fairness, we don’t know whether time has affected their opinions about this.)
I was always of the view that the fear of disruption determined the GOP’s apathy. Truly reforming the healthcare market would have been a far more serious disruption than Obamacare, touching the vast majority of people who were happy with their employer-provided insurance (effectively prepaid medical care programs) as well as those in the individual market.
The status quo is the small-c conservative impulse; the dawn of the Trump era demonstrates just how non-ideological and small-c conservative the GOP base is. The arguments Democrats successfully used against the GOP bills this year would have been summoned on steroids against any truly ambitious, conservative proposal. And once the GOP gave in to the progressive metrics for judging reform, the project was over. I have zero confidence the “compassionate conservative” version of the GOP would have been more successful in 2001-06.
Moreover, the argument that passing reforms takes issues off the table has been shown to be false. The big examples in 2010 were education and welfare. George W. Bush passed a bipartisan education reform bill; it proved to be unpopular, even in many Republican-led states and the Obama administration helped water it down. Welfare reform fared better until the Great Recession, at which point the Obama administration set about substantially weakening it and exploding the numbers of people taking food stamps and dropping out of the workforce to go on disability.
The notion that the Democrats, having sought government control of the health sector for decades upon decades, would have set aside their holy grail is belied by the Herculean effort they made to pass the then unpopular Obamacare in the face of predictions that premiums would skyrocket, the market would be destabilized, insurers would leave exchanges, etc. etc.
Lastly, as Tom Nichols notes, the GOP Congress is driven a base that wants Obamacare repeal, but cares so little about policy that it cannot evaluate the reforms the GOP Congress offers. This is a big part of how you end up with bills with 18-20% approval. Also, not caring about policy is a big part of How We Got Trump, who knows or cares so little about policy that he can’t shape or sell reform. And so the vicious cycle continues.
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