Whenever government attempts something beyond the proper role of government (protection of life, liberty, and property), it causes unintended consequences—usually exactly opposite to the stated goals of the interference.
That is an axiom of the Spherical Model. It comes up often when we’re talking about government policies. Today we’ll look at an example from this past week.
This US Senate came out with their version of “repeal and replace,” which, pretty much like the House’s version AHCA (American Health Care Act), doesn’t repeal, and only slightly modifies the original, inaptly named Affordable Care Act.
The ACA—or Obamacare, since it’s on him—claims to want to provide more affordable health insurance for the uninsured. It did so by astronomically raising insurance costs, reducing choice, forcing Americans to make a purchase whether they would choose to or not, and added in forcing companies to pay for practices against their beliefs (which the courts have somewhat corrected after attacks on nuns and others whose religion finds abortion unconscionable). People lost the health insurance they had. People lost their doctors. People found health care scarcer and more expensive. And the whole system is spiraling downward.
Let’s add that the ACA claimed it had the right to force all citizens to purchase health insurance as “a legitimate exercise of its expressly delegated power to regulate commerce among the states. The trouble is that the mandate does not regulate commerce at all. Rather, it forces people into commerce on pain of a financial penalty,” quoting Robert George in the Prager U video "Why We're Losing Liberty."
Another helpful video on today's topic is "Why Is Healthcare So Expensive?" A good 2 1/2-minute summary:
Meanwhile, since the ACA's partisan late-night scurrilous passage in March 2010, Republicans have been promising to repeal the whole of Obamacare and replace it with free-market reforms.
But now that they are in power, they hesitate—because the Democrats, amplified by the media, which is lopsided in favor of Obama and his ilk, announce that getting rid of the higher costs and less care of Obamacare means they want to kill thousands of people. Lies seem to have an effect on weak seekers of approval.
So, from the House we got the AHCA, American Health Care Act. At least they didn’t call it affordable. But it doesn’t actually provide health care either. It intended to adjust a few minor things. And it certainly wasn’t a repeal of the ACA as promised from 2010 through the election of 2016.
The freshly named BCRA, or Better Care Reconciliation Act, which is what the Senate is calling their version, does nothing to provide better care, or more affordable care—with a few provisos mainly put off until past some other election or decade. Nor would I say it reconciles reality with the pretended goal of more affordable health care for all. (The real goal of government, when it steps beyond its proper role is always to wield power.)
The BCRA will not pass with any help from Democrats. That means it requires all but possibly two Republicans to vote in favor. (There are 52 Republican Senators, plus VP Mike Pence to break a tie.) But Senators Ted Cruz, Rand Paul, Dean Heller, Ron Johnson, and Mike Lee all oppose it as currently written. Senator Heller thinks it needs more money going to Medicaid than any previous version, so let’s set him aside for now. The other four want to keep their promise to repeal the ACA and replace it with free-market ideas.
There are many who think they should just give up on their principles and go along to get along, even people I respect generally as conservative (Hugh Hewitt, for example).
I think it would be instructive to hear what these holdouts have to say. Together, they said this: "There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs."
Senator Cruz said, "Of course I'll compromise, if—and the 'if' is critical—we're moving in the right direction, if we are expanding freedom, if we are improving economic growth, if we are defending our nation."
Senator Lee wrote an op-ed giving his reasoning. I’ll just share parts of it:
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.
He’s not against compromise entirely; he’s been there done that:
[A]s 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.
What would make this clearly bad bill palatable to vote for?
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.
Here’s his reason:
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….
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 they couldn’t possibly do worse.
Just make a little room for choice. Allow a free market to try to find solutions. It doesn’t seem like that much to ask. And maybe he’ll get it.
I don’t know how to get policy passed that would do what is needed—but I do know what is needed. If we want affordable health care, we need government out of the way. The free market eventually leads to innovation and lower costs. Every time it’s tried. If only we tried it more often.