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Health Care and the Waiting Room

Republicans have been waiting for seven years to repeal and replace the hated Obamacare law, and it looks as if they’ll have to wait a while longer. The Senate’s majority leader has postponed a vote on a Republican alternative until after the summer recess, which will likely include some encounters with constituents that won’t make them any more eager to take up the matter when they return.
The Republicans have a president in the White House and a large majority in the House of Representatives and a slight majority in the Senate, the same advantage the Democrats held back when they rammed Obamacare through without a single Republican vote, but their revenge was never going to come easy. That Republican president ran on promises of no cuts to Medicaid and coverage for everybody, that House majority is largely comprised of more doctrinaire conservatives, and slim Senate margin includes both doctrinaire conservatives and more pragmatic sorts of Republicans from purplish states. Although they all ran on promises of repeal and replacement, the Republicans never did agree on what that should look like.
Back when the Democrats had the House and Senate and the White House they were all in general agreement on the basic principles that the government should be interfering more thoroughly in the health insurance market, consumer choices should be restricted, and more government spending should be allotted, so they had an easier time getting their bill passed. Even with a president boasting approval ratings in the 60s and plenty of support from support from the establishment media, however, the Democrats took until just before Christmas and had to resort to some bare-knuckle politics to ram through what was already an unpopular law.
Although the eponymous President Barack Obama won re-election three years later, the Obamacare law was unpopular enough that it was largely responsible for a Republican president and Republican majorities eight years after his supposedly transformative election. Such are the consequences of ramming unpopular legislation down the public’s throat on a strictly partisan vote, along with all the skyrocketing premiums and punitive mandates and other pains that have been inflicted on so many Americans, so the Republicans should count themselves luck for the delay.
Obamacare remains unpopular yet, and even its more honest defenders are admitting that some serious tweaking is required, both the House bill that was passed after an embarrassing delay and the Senate bill that’s currently delayed are polling far worse. Both cut back on planned increases in Medicaid, and they not only don’t cover everyone but leave an estimated 22 million looking for other options in coming years, and there’s no getting around that the tax implications tend to favor the wealthier taxpayers, so the politics is at least as tricky as the policy.
To our old-fashioned Republican way of thinking both the House and Senate bills represent a slight improvement on Obamacare, but come nowhere near the long-promised full repeal and replacement, we expect that whatever compromise version they might reach and pass on a partisan vote will prove unpopular enough to arrive at a Democratic president and a Democratic majority in at least one house in just three years or so. There’s a conservative case to be made for the the Republican bills, and a conservative case to be made against them, but the Republican president who promised no cuts to Medicaid and coverage for everyone and the free-market ideologues and the more pragmatic sorts of Republicans seem likely to persuade the public.
All of them promised their voters something like a repeal and replacement of Obamacare, though, and all of them are itching for something they can call a legislative win. We hope they get it, but we hope they take their time about it, and come to some agreement on the true principles that underlie a free and efficient health care system, and make that hard-to-explain case to the American people, and use the impending implosion of Obamacare to get recruit a couple of symbolic Democratic votes. They’ll probably take some short-term hits for that, but it’s the best plan for the long run, which will take a lot of time.

— Bud Norman

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