This Is How You Got TrumpCare: Republicans Don't Know What They Believe Any More

Ross Douthat has a column today titled “Why Republicans Can’t Do Health Care.” with a sentence that is jarring because of its obvious truth:

[T]here was no [health care] bill that could have united all of the right’s disparate factions, because on health care policy, as on a range of issues, the Republican Party as an organism does not know what it believes in anymore.


Republicans ran on a very simple promise: repeal and replace ObamaCare. Now that they’re in office, they remind me of the Joker in the scene from the Dark Knight in which he says: “Do I really look like I have a plan? You know what I am? I’m a dog chasing cars. I wouldn’t know what to do with one if I caught it!”

Imagine a world in which the Democrats managed to enact a policy of communism. Not the inching towards a European socialist state we’ve seen in recent years, but full-on Soviet-style communism, with five-year plans and centralized control of the economy — but with one difference: Americans still had a meaningful vote. Without a market mechanism to allocate resources, there would be suffering, starvation, and death, caused by shortages of basic commodities. The citizens would vote back in Republicans, who would run on an agenda of repealing Communism.

If that happened, what would Republicans actually do when they got into office? Would they really repeal Communism? Or would they worry about the political consequences of government telling voters that the state won’t hand out food any more?

Harry Browne famously said: “Government is good at one thing: It knows how to break your legs, hand you a crutch, and say, ‘See, if it weren’t for the government, you wouldn’t be able to walk.'” But if Republicans were voted into office on a campaign of repealing the Democrats’ leg-breaking program, they would fret about the reaction to taking away people’s crutches.


Friedrich Hayek once said: “The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.” TrumpCare isn’t the first time people have had the idea that a program run from a central government by a group of experts is the best way to allocate resources. Communism and socialism didn’t happen because nobody believed in such central planning. A lot of people believed in it. So they tried it, and people died by the millions. We have had countless micro-lessons since. The starvation in North Korea and Venezuela stand as a modern and visible testament to the dangers of central planning.

Yet these lessons doesn’t seem to have taken root in the minds of Republicans — the members of the only viable party that might possibly apply these lessons. The free market is the best system ever devised for allocating resources. But if Republicans ever actually believed that, they don’t seem to any more. Now that the details of the House’s TrumpCare bill have been announced, Republicans look for ways to compare its handouts to other handouts they like. They deride those who advocate for the free market as ideologues who don’t understand the real world.

But supporters of the free market understand the real world all too well. We understand that centrally controlled plans aren’t just bad on a theoretical level. They kill people.


Republicans seem to assume ObamaCare is different. We hear about 20 million people with health insurance and think: wow, maybe this time government did something right! Can we really afford to mess with it? What you’re not hearing from Big Media is ObamaCare is not having a positive impact on health, because it’s not having a positive impact on the holding of private insurance.

Anyone who thinks otherwise needs to read a piece in National Review titled No, Obamacare Has Not Saved American Lives by Oren Cass. Cass shows that ObamaCare has not improved health care. If anything, it has made it worse.

Cass notes that the ACA “is primarily an expansion of Medicaid” and that “in recent years, the share of Americans with private insurance has declined.” That’s right: declined. Because health insurance is still a function of employment, there have been gains during the tepid Obama recovery. But if you compare the share of non-elderly Americans who hold private health insurance before the recession and after the recession, the percentage has actually gone down. Even lefty PolitiFact, in one of their “this statement is true but we don’t like it so we’ll rate it Half True” hit pieces on Rand Paul, was forced to concede that “About 20 million people gained coverage and about 14.5 million of those were under Medicaid or CHIP.” The other 5 million or so gained coverage mostly because that’s what happens during an economic recovery.


The fact that the ACA expansion of covered citizens is a function of Medicaid expansion is important, Cass notes, because studies show that outcomes for patients with Medicaid tend to be worse than those of uninsured patients.

What’s the bottom line? ObamaCare is not saving lives:

Age-adjusted death rates in the U.S. have consistently declined for decades, but in 2015 — unlike in 19 of the previous 20 years — they increased. For the first time since 1993, life expectancy fell. Had mortality continued to decline during ACA implementation in 2014 and 2015 at the same rate as during the 2000–13 period, 80,000 fewer Americans would have died in 2015 alone.

But wait: does this correlation mean causation? Not necessarily, but dig deeper and you’ll find that we can compare the states that expanded Medicaid under ObamaCare to those that didn’t — and guess what? Expanded Medicaid is not improving health:

[T]hanks to the roughly half of states that refused the ACA’s Medicaid expansion, a good control group exists. Surely the states that expanded Medicaid should at least perform better in this environment of rising mortality? Nope. Mortality in 2015 rose more than 50 percent faster in the 26 states (and Washington, D.C.) that expanded Medicaid during 2014 than in the 24 states that did not.

If Republicans truly believed in the free market, they would see the relationship between centralized planning and ruinous outcomes as fundamental. They would make that case to the people. They would cite statistics like the ones I just cited.


But Republicans don’t believe in the free market any more. They believe in the same welfare-state principles as the Democrats, just on a slightly smaller scale. And so, to modify a popular saying:

This is how you got TrumpCare.




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