What the GOP Really Should Learn From Obamacare

At Vox, Sarah Kliff and Ezra Klein purport to reveal “The Lessons of Obamacare.”  Were I reviewing these lessons in a full column for The Federalist, I would probably spend a fair amount of space to mocking the delusion and disingenuousness shot through the piece.

For example, do they expect anyone to buy that they had to do extensive reporting to “unearth” the lesson that the Democrats — from Pres. Obama on down — should not have lied about the trade-offs their proposal entailed?

Conservatives noted this lying about trade-offs  throughout the Obamacare debate; even the New York Times conceded in the straight news part of the paper that promises about keeping your plan and doctor “may not be literally true or enforceable.”  People like Klein clowned themselves pretending the law was a success even after it passed, but now want to pretend they learned a lesson.

Similarly, Kliff and Klein again spread the horse manure about the individual mandate being an idea with substantial GOP support.  Avik Roy has called Klein out by name for this silliness in the past, but it’s apparently far too comforting a myth for Voxers to drop.

But the important part of their article is not what the GOP should learn from Obamacare.  Rather, the key point is that the GOP should learn what Kliff and Klein (and I) believe Democrats will take as the lessons of Obamacare.

They voxplain: “For Democrats, those lessons are relatively straightforward. It is easy to imagine the next Democratic president passing a health care bill that does four things: expand Medicaid coverage up to 200 percent of poverty, boost subsidies in the exchanges, add a public option that can use Medicare or Medicaid’s pricing power, and let people above age 50 buy into Medicare. ”

As progressives, Kliff and Klein are required to conclude that the failure of big government was that it wasn’t big enough.  But politically, they are probably dead on.

After all, the House GOP bill doesn’t even fully reverse O-care.  Democrats (and some conservatives) see a GOP that is not ideologically committed to fundamental reform and even dumb enough to accept coverage stats — the only measure by which O-care succeeds — as a metric of GOP success.

Republicans are not entirely ditching O-care’s Medicaid expansion now.  They would be no more likely to remove people from Medicare.  Thus, the next Democratic strategy will center around a squeeze play that is simpler (indeed, one more in line with Obama’s claim to “build on what works”) and more difficult to reverse.

The GOP lost the war over O-care in part because they thought they were fighting the last war.  Instead, polarization made a larger Dem majority more unified, even willing to accept a bill that bought off the interest groups who helped torpedo Hillarycare in the 1990s.

The GOP — and conservatives — really ought to be looking at approaches that anticipate the next time the Dems control Congress and the White House.  That approach could be something radically more free-market than anything on the table now.  Or, given the that the GOP really isn’t all that conservative, it could be something more like Avik Roy’s plan, modeled on the universal coverage plans in Switzerland and Singapore.

It’s probably too late for the GOP to think that many moves ahead, rather than continue to fight the last war.  The GOP’s nickname as the Stupid Party is often well-earned.

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The Flight 93 Presidency

Remember “The Flight 93 Election“?  This was the (in)famous essay in which “Publius Decius Mus” (now ensconced in Pres. Trump’s NSC) essentially posited the 2016 vote was between Trump and The Death of America.

What people tend to forget about the essay is that (like most of its genre) it was far more an attack on conservatives than an argument for Trump.  Publius mostly contended that if conservatives were sincere in their concerns, they must believe that America is headed off a cliff, and their failure to embrace Trump as the only viable alternative to the End Times revealed their insincerity and their lack of faith in their own philosophy.

Well, the GOP stormed the cockpit and put Trump in the pilot’s chair.  One of his first major acts as Pilot-in-Chief is throwing his weight behind the House GOP’s draft American Healthcare Act, also known as “please don’t call it Trumpcare, even though we’re calling it terrific.”

Even if it’s unfair to call it Obamacare 2.0 (there are, for example, some things to like in the Medicaid reform piece of the bill), Trumpcare is the legislation of pale pastels, not bold colors.  It does not even restore the pre-Obamacare status quo, which already had too much government distortion of the healthcare sector.

Trumpcare is nowhere near a proposal that reforms the healthcare and insurance industries in the way Republicans and conservatives have been arguing for years (even if they also argued about the details).  I also seriously doubt that “phase three” of the GOP healthcare agenda will significantly advance those goals, even if they manage to get it through the Senate.

Trumpcare is a classic case of the conservative critique of the Congressional GOP.  For years, the GOP has declared Obamacare a major step toward the death of the Republic (not an unfair point), but now has underdelived again, breeding more of the mistrust and cynicism that fueled Trump’s ascent to the White House.

The difference this time is that Trump is fully supporting this miquetoast mish-mosh.  Given his past statements that “[w]e’re going to have insurance for everybody” and “the government’s gonna pay for it,” that’s not surprising.

Trump’s endorsement of marginal tinkering, however, does put the lie to the so-called argument of Publius and those echoing his attacks.  For the Ever Trumpers, it appears that as the ground rushes upward toward the plane, pulling up five or ten degrees is perfectly acceptable, so long as Trump is in the pilot’s chair.

In fact, it’s worse than that.  Trump reportedly told leaders of conservative groups that if Trumpcare fails, his strategy will be to allow Obamacare to fail and let Democrats take the blame.  He’s apparently considered letting the plane crash, to the extent that he can get some political gain out of it.

The Ever Trumpers won’t object, because their apocalyptic pose is every bit as phony as their postmodern nihilism.  Flight 93 passengers they ain’t.

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Trumpcare Will Likely Pass. It Won’t Be Pretty.

Let’s start with tweets, then additional thoughts.

The Federalist’s co-founder Sean Davis:

I tend to agree with this.  It is basically how Obamacare was enacted.  But not exactly.

Pres. Obama began buying off “stakeholders” (affected industry groups) before there was draft legislation. This was a key difference from the way Hillary Clinton ran her failed healthcare task force in the1990s.

Also, while Obama did not submit a draft bill for Congress to consider, he had signaled his position on key issues, e.g., exchanges, acceptance of individual and employer mandates, and a possible “public option” competing with private insurers in the exchanges.

It does not appear that the House GOP consulted insurer or hospital groups, while a tweet from Pres. Trump panicked trading in pharma stocks.  The American Hospital Association issued a letter of opposition to the bill.

The AARP supported ObamaCare because it was trading off Medicare cuts for expanded coverage that was potentially quite lucrative for AARP.  The powerful seniors’ lobby is opposed to the House GOP proposal.

Meanwhile, the lack of coordination between the White House and Congress appears to extend to this first major legislative effort.  Indeed, on Monday, Trump claimed that “nobody knew that health care could be so complicated,” suggesting a certain lack of engagement with the subject.

VP Mike Pence told Congress that “this is the bill,” wile being “open to improvements.”  OMB Dir. Mike Mulvaney, otoh, is stressing the latter, though it seems as if he’s telling conservatives to propose amendments and daring them to vote against the bill if those amendments fail.  Unity!

There also seems to have been no outreach to conservative groups like Heritage, Americans For Prosperity, FreedomWorks, etc., who largely blasted the draft bill.  And the communications strategy seemed non-existent, as House leadership scrambled to explain that this proposal was only the first step or “phase.”

Absent these failures, the House GOP might not be in the position it is now.  Moreover, given Tuesday’s reaction, I would not assume the draft bill resembles an “okay final deal,” even if it might have been on Monday.

In addition, the general lack of White House guidance potentially distinguishes this effort from the Obamacare effort in another way.

With eight GOP Senators raising objections to various major provisions of the House proposal, there is the risk that the bill — or some disputed positions — will die in the Senate.  Some House members will be loath to climb out on a limb that may be sawed off.

This brings us to the unstated common denominator between Obamacare, which passed, and the BTU tax which died (and Hillarycare, and the 2009 cap-and-trade plan that died in the Senate).   Now that repeal/replace/repair/whatevs is on the table, Obamacare is finally sort of popular, albeit by only a few percent. In fairness, much depends on how you ask the question:

But even if you assume that support for O-care is rising in part because the Left now feels it can’t pout over not getting a single-payer system, some of it may also be from people fatigued with disruption of their healthcare arrangements, or those who don’t trust the government to make things better after falling for past promises.

It cannot have escaped the Congressional GOP’s notice that Congressional Dems once delivered on what they promised their base, ramming through a sweeping bill that altered a broad sector of our economy, only to be defenestrated by angry midterm voters.  It’s a big part of why many of those Republicans hold office today.

Running a similar game plan now has to be unnerving.  Arms will probably have to be twisted to the breaking point at the end of the process.  Getting the policy right, and the comms strategy right, and the coordination right would be helpful to those looking for nerve at the beginning.

UpdateThe AMA opposes the House bill.  There will be people who think that interest group opposition is a feature, not a bug.  It viscerally appeals to me as well.  But the White House and Congress aren’t making passing a bill any easier.  People generally trust their doctors, who will be hearing bad things from the AMA.  This is the sort of thing that helped doom Hllarycare.

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