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More Conservative Than Thou
In our ideologically scrambled age, it’s getting very hard to tell who’s who.
Political conservatives have been opposed to “socialized” medicine pretty much forever. Republicans who agreed with this philosophically paid a heavy political price as Democrats rolled out the “Mediscare” tactic every election season.
But how are we to make sense of the cross currents on the right regarding the American Health Care Act? The groups often associated with the “hard right,” like the House Freedom Caucus, the Club for Growth, and Heritage Action have panned the bill as “Obamacare 2.0.” Rep. Mark Sanford noted that “From a conservative’s perspective, there are a number of things that need further refinement. This notion of a refundable tax credit is a big deal, Medicaid expansion is a big deal, the Cadillac tax is a big deal.” Rep. Jim Jordan offered that this bill is “Obamacare in a different form. That is not what we promised the American people that we’re going to do.”
Cynics might note that some Republicans who publicly oppose the AHCA for not going far enough in a rightward direction are secretly hoping that the bill fails because Obamacare is actually reasonably popular with their voters.
The president, who is not a conservative, at first seemed to back the AHCA. “Our wonderful new Healthcare Bill is now out for review and negotiation. Obamacare is a complete and total disaster – is imploding fast!” he tweeted.
But the Trumpian populist media like Breitbart and NewsMax may be hostile to the AHCA for other reasons. Fox News commentator Laura Ingraham lamented that the bill lacks the “Trumpiest” features of healthcare reform, and Breitbart — never subtle — is calling the bill “RyanCare.” What are the “Trumpy” features of health reform? Trump’s campaign promise of a replacement for Obamacare that would cover everyone and cost less was cotton candy.
The AHCA can be understood as that most reviled of creatures in Washington, DC – a compromise. It begins with the understanding that due to the extreme partisanship of the nation and the Senate filibuster rule, Republicans must devise a bill that can pass the Senate with 51 votes though “reconciliation.” Only matters touching directly on budgets and deficits can be included. That’s why the AHCA leaves many of the Obamacare regulations in place.
As a conservative, I would love a bill that actually created a free market in health care. We haven’t had one since before World War II when Congress made employer-provided (but not individually purchased) coverage tax deductible, and particularly since 1965 when Medicare and Medicaid were enacted. Congress further distorted the market in 1986 by requiring hospital emergency rooms to treat everyone regardless of ability to pay. Those costs were passed on in the form of higher medical bills for all. The third party payer problem and government distortion of prices has resulted in medical inflation running twice the level of the Consumer Price Index for five decades. Everything government has done to make health care “affordable” has made it more expensive. Obamacare doubled down on everything that was wrong, basically outlawing the whole idea of medical insurance – i.e. a plan you buy to guard against a health disaster like an accident or cancer – in favor of prepaid medical services that are funded (well, in theory) by forcing healthy people to purchase plans that are “ACA compliant.”
The whole system would make Rube Goldberg blush. And as much as we might wish for a sword to cut the Gordian Knot, the only politically possible options seem to be slow turns away from the single-payer precipice, perhaps in stages.
The ACHA takes some steps in that direction, particularly the reform of Medicaid, the move toward Health Savings Accounts, the repeal of $1 trillion in taxes, and revoking the medical device tax. But compared with current law, the bill is hard on the working poor, and too generous to those at the upper end of the income scale. As health policy guru Avik Roy has objected, the subsidies ACHA offers to those making between $75,000 and $150,000 are actually more generous than Obamacare’s subsidies. For the working poor, by contrast, who make too much to qualify for Medicaid, the subsidies would be much smaller and probably inadequate.
The rush to pass the ACHA – leadership had planned for a vote by next month – is based on political momentum, and that’s understandable. Political capital is a highly perishable commodity. But Republicans would be well advised to slow down and improve the bill. They should not follow the Hollywood script doctor’s demand: “I don’t want it good, I want it Tuesday.”
Published in General
This article pretends that Paul Ryan is not the Republican leading the support for this legislation.
The problem happened when the Left forced the narrative from “Repeal” to “Repeal and Replace” – we need to stop talking that way now.
We need to work to make the marketplace less restricted – the government needs to get out of that business. Stop forcing insurance companies to cover things that people do not want. Insurance doesn’t cover Band-Aids, why is the government forcing them to cover condoms?
The House’s mistake is thinking we need to “Replace” Obamacare. You cannot replace Obamacare with anything that doesn’t look like more Socialism. We should just Repeal it and let the free market have Insurance back.
And please stop calling it “Health Care”! This is about Health Insurance, not Care!
I don’t know if “slow down” is the answer. How much slower can they get?
As someone whose income is in that range and who often pays out of pocket for health insurance (to the tune of around $5,000 last year – yes, for insurance, not for co-pays and such), I think this is a great idea. Most people in that earnings bracket have employer-provided coverage, but people lose jobs (and need COBRA), change jobs (and have waiting periods), are self-employed, or have substantial cost-sharing of premiums with their employers. Those costs are paid with after-tax dollars.
Generally, that’s an income bracket with a very high marginal tax rate, wherein a lot of tax exemptions have already been phased out, and, while there’s disposable income, it’s still firmly middle class.
Only a fool makes severe compromise his opening bid. That “momentum” could have been spent on proposals worthy of this once-in-a-lifetime conjunction of Republican elections. This is legislation that might have been proposed years ago.
Republicans expressed surprise in response to their electoral gains. They never expected to utterly dominate both houses of Congress. Yet they ran on repeal, not amendment. Simply put, they lied.
They haven’t proven useless yet. There is plenty of time to regain the grudging approval of voters. But they just spat in the eyes of their supporters.
Can you compare and contrast this with the [redacted] view?
I’m in the same boat, this would actually do a lot for my family…we pay around 14,000 per year in premiums alone…with a $6000 deductible, so any help AT ALL would be welcome indeed. The ACA has done so much to hamstring my ability to get ahead despite all my hard work. We are contemplating having no insurance and taking the penalty which would be far less than what we’re paying since everything is out of pocket costs anyway and putting the $14000 in the bank for medical emergencies.
The new bill allows for catastrophic health insurance again. If it’s back to being catastrophic (rather than this mess of ObamaCare, with high deductibles to offset various useless mandates), then it’s cheap, and the $14,000 can be used for a combination of premiums, HSA payments, and savings.
You might feel the way I do: for people in our income bracket, low-cost catastrophic is perfect. I can’t afford to pay for cancer out of pocket, can afford $10k if the [CoC] really hit the fan in a particularly bad medical year, but find it borderline insane to pay $5k of premiums every year for my mid-thirties, healthy self.
Tom Cotton’s “slow down” argument makes no sense. The danger isn’t that the Republicans in Paul Ryan’s US House of Representatives will move too quickly; the danger is the Republicans in Tom Cotton’s US Senate will allow the legislation to be talked to death via the filibuster.
It’s understandable that the Democrats want to play the game of delay. But why does Tom Cotton, of all people, want to assist the Democrats’ strategy?
On Laura Ingraham’s radio talk show, she interviewed Paul Ryan and criticized Ryan’s entitlement reform of Medicaid, saying that it could “bust state budgets.” What? So, now “conservatives” oppose entitlement reform because state governments irresponsibly embraced Obama’s Medicaid expansion? So, now “conservatives” are in favor of Medicaid’s open ended spending?
Never open with a compromise. Open with at least what you want, better yet more than what you want.
Ryan’s legislation uses reconciliation, therefore it cannot be Filibustered.
The danger is that whatever happens to Healthcare Reform next the Republicans own it, if they change Obamacare. The changes need to be more conservative than Obamacare and they need to work.
Everyone likes to discuss how Healthcare is like 1/6 of the economy. If you are going to own the results of a reform, wouldn’t you rather that it be something that works and has more parts that you like that dislike, that even after compromises you are if not proud, at least not ashamed of what you came up with?
More than “speed” being the issue, Paul Ryan created a mess. It is not his plan but his role out. When this was released it was done in typical Congressional fashion. “here is the bill take it or leave it” You want the Senate to vote on something then the have to have a say in the bill, not take it or leave it.
Avik Roy huh?
All the health care policy guru horses,
and all the health care policy men,
will not put health care back together again.
Republicans have owned the health care system since November 8, 2016. They can’t weasel out of it and say “It’s the Democrats’ fault.”
At least Paul Ryan is getting off of his fat apathy and reforming the Medicaid entitlement program.
Tom Cotton is having a beer and letting the country go bankrupt. Maybe that’s because Arkansas has a lot of Medicaid recipients.
If Tom Cotton has other ideas about health care reform, he should introduce them in legislation, not council dithering and delay.
Senator Tom Cotton is content to sit on the sidelines, throwing tomatoes at any other Republican who makes any effort at reforming America’s dysfunctional health care system.
We need US Senators who are willing to engage the issue from a conservative perspective, not stab other Republicans in the back as they try to unravel the complicated mess Obama (and previous presidents and congresses) created.
Paul Ryan’s bill represents the largest entitlement reform in US History and a very large tax cut as well. It expands Health Savings Accounts.
What does Tom Cotton do? He tells the US House to slow down and let the Democrats run out the clock.
No one has the ability to prevent the US Senate from legislating. Not even Paul Ryan can tell the Senate that no amendments can be made, that there must be an up or down vote on his legislation.
If Ryan’s bill passes the House, then the Senate can add any amendments it wants, including anything that Tom Cotton proposes.
Rather than tell the House to slow down, Cotton should be writing up his own health care legislation and presenting it to other Senators, persuading them to support it.
Ryan has to get 216 votes in the House. Just getting the votes of the most conservative members of the House will not cut it.
I don’t understand why they are saying they need a super majority to win in the senate.
They also have the ability to tell the courts that they don’t have jurisdiction over health care bills, if they so choose. There’s a lot of things they can do. They just don’t want to.
Our margins are not so large. Just getting the conservative members will not pass a bill. Not getting the conservative members will also not pass a bill.
Please do let Mr. Ryan know how legislation is supposed to work. He is the one who said initially that if there were any changes to his bill it would not work.
I, for one think Cotton, Cruz, Grahm, Grasley and Paul are being helpful. Letting the House know in advance that what they have will not work. Sure the Senate can come up with its own plan. Some Senators, like Paul, have done so in the past. If it is completely different in every way from the House, it will be more than they can combine in conference and nothing will get done.
I suppose those of us disappointed with the bill need to be reminded of political reality. There is a wide variety of Republican opinion on healthcare, not all of it conservative. There are some conditions that need to be met in order for the bill to garner the support it needs to pass.
Given these constraints I’m never going to get what I want. So, if its better than Obamacare, pass it.
This is probably one of the main reasons why the bill came out the way it did. trump was adamant the entire campaign through that he wanted something approximating obamacare, hence why the bill is as close as it is to its predecessor. After all it doesn’t matter if it can get through the senate and not the President since he is presumed leader of the party and can thus exact “discipline”.
Let’s focus on point 4. The bill must be eligible for reconciliation so that 51 senators is enough to pass it.
Ryan has been criticized for taking a restrictive view of reconciliation and, thus, bringing up a bill that doesn’t repeal enough of Obamacare. Fine. But Republican Senators are not powerless over this, since they can offer amendments to Ryan’s bill on the Senate floor. If the parliamentarian holds that these amendments do not qualify for reconciliation, Republican Senators can overrule the parliamentarian.
But your original point is very accurate and important: Not all Republican opinion on health care is conservative. Paul Ryan has to cobble together votes from left and right Republican factions in his caucus. Not easy.
I thought the whole point of reconciliation was to severely limit the proposition of amendments. If Republican senators can offer amendments doesn’t that mean Democrats can too? If they overrule the parliamentarian is the bill open to a filibuster?
Why is [redacted] redacted but “Trumpian populist” not?
In reconciliation debate is limited to either 20 hours or 50 hours, I can’t remember which. Amendments are not severely limited, however. Democrats can offer amendments and they will. If the Senate were to overrule the parliamentarian, the bill is not open to a filibuster. In a sense, overruling the parliamentarian is exercising the nuclear option. It’s rarely done. But it can be done by a simple majority vote.
I don’t care about ‘ideology’. I care about LIBERTY. Our last president like to lecture us about ‘who we are’. Forcing people into healthcare plans they don’t want, and that are designed to benefit other people (not them) is not ‘who we are’ as a country. Or perhaps ‘who we were’. What a sad thing we’ve come to this – because its not moral, and even more importantly, it won’t work. Its funny how ‘spreading the wealth’ leads to more poverty and how ‘social justice’ leads to an unjust system.