Why Rand Paul Is Wrong About Graham-Cassidy
The strange spectacle of a federalism-promoting senator being unwilling to support a bill which promotes federalism
While the Donald Trump era has made Washington, DC moderately more more entertaining, it has done little to change how the Beltway operates. Democrats still hate Republicans, Republicans still hate leadership, and Wall Street still controls the Treasury. So it goes.
When I had heard that a last-second Obamacare reform bill had come out, I assumed that — like Ryancare, “Skinny Repeal,” and other such gimmicks — we were dealing with another Obamacare-lite measure that did little more than propose just enough cosmetic adjustments so that Republicans could publicly campaign on having “repealed” Obama’s signature legislative achievement.
To my great surprise, I was wrong. While far from being my ideal bill, the Graham-Cassidy-Heller-Johnson Plan is one of the most impressive reforms of its scale that has been proposed in a long time.
From the beginning, the most important benchmark I’ve had in judging healthcare reform is how it handled the individual mandate. Not only am I repulsed by the idea of government having the power to mandate you purchase a product simply because you exist, but the mandate undermines one of the most important developments in American healthcare: the growth of the direct primary care model.
In an effort to get out from under the insurance strictures put in place by Obamacare, doctors have increasingly returned to the old-fashioned approach of dealing directly with their patients. Most charge a simple flat fee for near-unlimited access to basic service. The upsides are obvious: fewer instances of paperwork, fewer restrictions, and fewer costs.
Of course, those who currently use such services must still pay for costly ACA-compliant health insurance plans, or pay for it at tax time. This is wrong, and if Graham-Cassidy did nothing more than repeal this tax, the bill would be deserving of support.
This is why Rand Paul’s emphatic stance against Graham-Cassidy is so bewildering. Listening to the senator defend his position, it’s not clear he understands why either.
At first, Paul claimed that Graham-Cassidy keeps 90 percent of Obamacare. This is simply incorrect, which is why he shifted to talking about 90 percent of the “spending and taxes” of Obamacare. Although this is closer to the truth, surely as a supporter of the “Penny Plan” Paul can agree that modest real cuts in spending are better than no cuts at all.
Furthermore, the tax cuts included in the Graham-Cassidy bill target some of the worst parts of Obamacare, parts that making patients pay more for prescriptions and medical devices.
When pushed further, Senator Paul tries to dismiss Graham-Cassidy’s block grant approach by mocking the notion that states would be any better at running Obamacare than the federal government is. Not only does Paul blatantly misrepresent the power Graham-Cassidy offers states in crafting their own programs, but the superiority of a decentralized model over a single Washington monolith should be obvious to a legislator who constantly — and correctly — highlights the advantage of federalism.
As Berny Belvedere points out:
Beyond defederalization, which is independently attractive to many conservatives, Graham-Cassidy would create a regulatory arena that facilitates greater fiscal restraint. States can’t just print money to overcome shortages, which is a major reason why, for all their complaining about total funding numbers, fiscal conservatives should prefer Graham-Cassidy over Obamacare.
What is more, if we move past ideals and instead focus on realpolitik, kicking important decisions to states would be a huge advantage to Paul’s small government allies who have proven to have more influence in various state legislative chambers than they’ve ever managed in the beltway.
It is really strange that Paul doesn’t see all of this.
Is Graham-Cassidy a silver bullet for all that plagues American healthcare? Of course not. But neither was Rand Paul’s own proposal. Washington has spent 100 years screwing up healthcare, and it’s going to take more than a single bill to fix it.
Instead of trying to fix federal policy that may very well be unsalvageable, the focus for Paul and other reformers should be empowering Americans to opt out of bad programs, rather than fixing it. That should be true for healthcare, education, social security, and even money.
By eliminating the individual mandate and helping empower direct primary care providers, Graham-Cassidy passes that test.
Hopefully Senator Paul can come to understand that, and save this bill. It may not be enough, given that the bill can only suffer a total of two Republican defections, but one of them should not be Rand Paul.
