An unforced error: Why introduce yet another Obysmalcare repeal bill when you don't have the votes to pass it?

From The Wall Street Journal:

Trump Applies Late Pressure to Senators in Health-Bill Push

Saturday tweets aim at McCain, Paul and Murkowski

By Kristina Peterson | Updated September 23, 2017 11:27 a.m. ET

WASHINGTON—President Donald Trump on Saturday pressed holdout Republican senators to support a GOP health-care bill, in a bid to revive Republicans’ last-ditch effort to roll back the Affordable Care Act one day after the defection of Sen. John McCain (R., Ariz.) appeared to doom it.

Mr. Trump’s Saturday morning lobbying faces long odds in resurrecting a bill that Senate aides from both parties viewed as close to dead Friday night. Senate GOP leaders can lose no more than two Republican votes to have any hope of passing the bill from GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.

The bill would repeal many of the 2010 health-care law’s provisions and provide block grants that states could use to set up their own health systems. All Democrats are expected to oppose it.

“Large Block Grants to States is a good thing to do. Better control & management,” Mr. Trump tweeted Saturday. “Great for Arizona. McCain let his best friend L.G. down!”

Mr. McCain was the second Republican to oppose the bill, following Sen. Rand Paul (R., Ky.) On Friday Sen. Susan Collins (R., Maine) said she was leaning against the legislation.

Mr. Trump said Saturday that he hoped to persuade Mr. Paul to change his mind.

There’s more at the link.

The blatantly obvious question is: why did this even come up if the Republicans didn’t have the votes to pass it? The failure of the GOP to repeal the Affordable Care Act has already hurt the senators with their constituents, but most of the blame was falling on Senator McCain. Mr McCain doesn’t care, because, impolitic as it is to say, he is a dying man,¹ who will not live to see another re-election campaign. Senator Paul was just re-elected, and doesn’t face the voters again until 2022, while Senator Collins had already voted against ACA repeal in 2015.

But the biggest failure is on President Trump, who said in his campaign that:

Those were pretty grandiose promises, promises which had not been met under President Obama’s Affordable Care Act. If Mr Trump had any real idea about how he was going to keep these promises, he never put those plans on paper. Once he became President, he never had that “beautiful picture” he promised in any form that he bothered to submit to Congress for approval.

The Republicans campaigned not on simply repealing the ACA, but on repealing and replacing it. Thus far, they have been unable to come up with anything different enough from the ACA to meet their promise of repealing it with a different, better replacement. Where is President Trump’s plan? When is he going to present a program which will take care of everybody much better than they are taken care of now?

Let’s face facts: none of the Republican plans have been anything more than Obaminablecare Lite, because there are only so many ways you can utilize the private, for-profit insurance system to force coverage for everybody.

The plain fact is that about half of Republicans — including me — objects to Obysmalcare not due to the way in which it attempts to provide insurance coverage for everyone, but that the government is trying to provide health care coverage for those who cannot or will not pay for it themselves in the first place. The problem is that the other half of Republicans might hate Obumblecare but agree with the cockamamie notion that the government should be responsible for providing health care coverage, and the GOP’s electoral advantage depends in part on a significant number of people who would lose health insurance or Medicaid if the current law is repealed.

There are only two significant ways to change the laughably-named Affordable Care Act: either total repeal, with no replacement, or single-payer. Every Republican congressman and Senator knows that voting for repeal only will take away health care coverage from some of the voters who put them in office.

There are only a limited number of options:

  1. Some form of single-payer plan, such as extending Medicare to cover all Americans;
  2. Some form of guaranteed private insurance, which is how the Affordable Care Act works; or
  3. Ending the federal guarantee of health care coverage.

The Republicans have already accepted that the guarantee is an established principle, so the third option has been taken off the table! That leaves us with either single-payer, or something at least similar to the ACA, and the Republicans proved unable to craft anything different enough from the ACA to both gain the necessary support and be different enough from the ACA to keep their promise to repeal it.

And now, Senator Bernie Sanders (S-VT)² has introduced his “Medicare for All” plan. Even though I have previously stated that a single-payer plan is the only rational way left to go, the failure of the ACA being obvious, I do not support Mr Sanders’ plan, because it is just another rob from the rich to provide more welfare scheme. The Democrats are falling in line behind Mr Sanders’ plan, and are almost certain to campaign on it in 2018 and 2020.

If the Republicans have no better plan than the Affordable Care Act, then they might as well find a way to institute single-payer along lines that conservatives can at least grudgingly support:

  • Paying for the plan would fall on everyone, by increasing Medicare taxes to somewhere around 20%, with half falling on the employee and half on the employer. Employees would have their increased taxes offset by losing the need to pay private insurance premiums. The biggest losers — and there are always some losers with any government plan — will be the employers who do not currently provide health insurance plans.
  • The plan should cover necessary medical care costs only: voluntary procedures, such as plastic surgery in non-disfigurement cases, and abortion, should not be covered. Glasses and contact lenses should be covered, but vision correction surgery should not.
  • Only American citizens and legal United States residents should be covered; illegal immigrants and tourists should be excluded.

That list is hardly exhaustive, and other reforms could make a lot of sense. But time has come for Republicans to take the lead, and structure single-payer as efficiently as possible, without turning it into a welfare program. It has to dramatically reduce malpractice claims, by restricting any damages to actual damages, and end punitive damage claims. More, by making it a Republican program — one which will attract the support of many Democrats — it will completely undercut the Democrats’ biggest campaign issue for years to come, and structure the program on a pro-life basis.

I do not like single-payer, not in the slightest; to me, it’s only advantage is that it will be less bad than the ACA or something similar. I expect health care under single-payer to get worse, to something similar to what Sachi ab Hugh described concerning Japan’s single-payer system, or with the built-in delays used by Canada and the United Kingdom, and our own Veterans Administration, to control costs. But when even the Republicans will not end the federal guarantee, we have no other realistic option.
Cross-posted on The First Street Journal.
¹ – Already 80 years old, Mr McCain would not face the voters again until he is 86 years old, if he chooses to run again. Having recently been diagnosed with glioblastoma, an aggressive form of brain cancer. Standard treatment options for this tumor include chemotherapy and radiation, although even with treatment, average survival time is approximately 14 months.
² – Mr Sanders is typically styled as an Independent, but I choose to designate him as he truly is, a Socialist.

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