The Missing Ingredient in BCRA: Humility
No, the Senate healthcare bill released yesterday does not repeal Obamacare. It doesn’t even significantly reform American healthcare.
It cuts taxes. It bails out insurance companies. It props up Obamacare through the next election. It lays out plans to slow Medicaid spending beginning in 2025, but that probably won’t happen. And it leaves in place the ham-fisted federal regulations that have driven up family health insurance premiums by 140 percent since Obamacare was implemented.
As the bill is currently drafted, I won’t vote for it.
On the other hand, I understand the opportunity Republicans have right now to help Americans get better, more affordable coverage.
That’s why I joined the Senate working group on healthcare reform with an open mind. I knew then, as I know now, that as one of the most conservative Republican Senators, I would have to compromise with the least conservative Republican Senators to get something done. And compromise I have!
At the beginning of this process, I wanted a full repeal of Obamacare. Despite campaigning on that very thing for eight years, my Republican colleagues disagreed.
So then I called for a partial repeal, like we passed in 2015 — and which conservatives were promised by our leaders in January. A partial repeal would at least force Congress to start over on a new system that could work better.
So then I advocated repealing Obamacare’s regulations, which have been the primary drivers of spiking premiums. I repeated this suggestion at every single meeting of the working group, and at every members lunch for several weeks. Yet when the Better Care Reconciliation Act was unveiled yesterday, the core Obamacare regulations were largely untouched.
Far short of “repeal,” the Senate bill keeps the Democrats’ broken system intact, just with less spending on the poor to pay for corporate bailouts and tax cuts. A cynic might say that the BCRA is less a Republican health care bill than a caricature of a Republican health care bill.
Yet, for all that, I have not closed the door on voting for some version of it in the end.
Conservatives have compromised on not repealing, on spending levels, tax credits, subsidies, corporate bailouts, Medicaid, and the Obamacare regulations. That is, on every substantive question in the bill.
Having conceded to my moderate colleagues on all of the above, I now ask only that the bill be amended to include an opt-out provision, for states or even just for individuals.
The reason Americans are divided about health care (like so many issues today) is that we don’t know exactly how to fix it. Politicians hate to admit it, and partisans like to pretend otherwise. But it’s true.
And history teaches us that when we don’t know how to solve a problem, the best thing to do is to experiment. We should test different ideas through a cooperative, bottom-up, trial-and-error process rather than imposing top-down, partisan power-plays that disrupt the lives of hundreds of millions of people at a time.
Eight years ago Democrats created a one-size-fits-all national health care system… and it’s collapsing around us. They couldn’t even make the darn website work!
Why do Republicans — who are supposedly skeptical of government miracle-working — expect our one-size-fits-all scheme to work any better?
The only hope for actually solving the deep, challenging problems in our health care system is to let people try out approaches other than the ones a few dozen politicians thought up inside the D.C. bubble.
And so, for all my frustrations about the process and my disagreements with the substance of BCRA, I would still be willing to vote for it if it allowed states and/or individuals to opt-out of the Obamacare system free-and-clear to experiment with different forms of insurance, benefits packages, and care provision options. Liberal states might try single-payer systems, while conservatives might emphasize health savings accounts. Some people embrace association health plans or so-called “medishare” ministry models. My guess is different approaches will work for different people in different places — like everything else in life.
The only way to find out what does work is to find out what doesn’t. We know the pre-Obamacare system was breaking down. Now we know Obamacare is failing too. I doubt the BCRA system would fare much better, or that the next Pelosi-Sanders-Warren scheme Democrats cook up wouldn’t be even worse.
At some point Washington elites might at least entertain the possibility that we may not have all the answers. I think right now — with President Trump’s shocking upset of the establishment still fresh in our minds — would be a good time for Congress to add a new ingredient to its legislative sausage: a dash of humility.
To win my vote, the Republican health care bill must create a little space for states and individuals to sidestep Washington’s arrogant incompetence, and see if they can do better. Recent history suggests Washington couldn’t possibly do worse.