While House Republicans celebrated with President Trump on Thursday over the passage of the American Health Care Act, Senate Republicans were already beginning to back quickly into the underbrush to avoid the blowback.
Now, it’s not as though the AHCA actually repealed Obamacare. It didn’t. The AHCA left many of Obamacare’s key provisions in place, and replaced others with back-door versions of the original Obamacare provisions. Pre-existing conditions coverage will remain a federal mandate, with the possibility of state opt-out with a federal waiver (politically unlikely); essential health benefits remain a federal mandate, with the possibility of state opt-out with a federal waiver (politically unlikely); the individual mandate is gone, replaced by a forced 30 percent fine by insurance companies on people who drop out of the insurance system and then wish to buy back in after a year; a new entitlement program has been created to cut checks in the form of tax credits for health insurance, without true means-testing, which effectively means pricing a bunch of poor people out of insurance while encouraging people to remain on Medicaid; regulations on age pricing remain, but have been loosened from 3:1 to 5:1; the feds will send $138 billion to the states to subsidize premiums in high-risk pools; regulations requiring insurance companies to charge the same prices to men and women remain, despite their physical differences; if a state does not have a high-risk pool, it cannot do away with Obamacare regulations.
On the plus side, the legislation does turn Medicaid into a block grant over time while allowing the pool of those joining Medicaid to expand until 2020; it cuts most of the Obamacare taxes; it ends the regulations governing employer mandates; it allows capped coverage again in the insurance market, promoting competition. It’s a mixed bag, in other words. But even that mixed bag is too much for the "moderate" Senate Republicans.
Here’s the bottom line: the Republican legislation, as much as leftists cry about, means that both parties now endorse the notion of a government-run healthcare system. It’s just a question of grays now. On Friday, Senator Bill Cassidy (R-LA) endorsed the Bernie Sanders formulation: “There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care.”
With this view, nationalized health care is right around the corner. As Charles Krauthammer stated last night on Fox News, “Over the past seven years, people’s expectations have changed…the country is at a point where I think it believes in universal coverage….Within a few years there won’t even be an argument about whether or not government has an obligation to ensure that everybody gets health coverage.”
There is no right to health care. You do not have the right to put a gun to my wife’s head (she’s a family physician) and demand care, or demand that the government do so. Rights pre-exist government, and government is maintained in order to preserve those rights. That is what the Constitution and the Declaration of Independence proclaimed. There is a right to access to health care, but once you declare a right to health care, only compulsion can achieve the realization of such a right. Passing the AHCA may move the health insurance industry in the right direction. But by proclaiming it a “repeal and replace,” as Trump and the Republicans have done, they’ve endorsed government-guaranteed health care, and then wrongly slapped the “free market” label on it. That’s a disaster in the making. The shortcomings of the AHCA will now be blamed on the free market rather than on the government. At least when Obamacare failed, people knew to blame big government; if the AHCA fails, people will blame deregulation. That will be Republicans’ fault.
Obama won and continues to win because he shifted the political ground upon which Republicans now walk. Not one elected Republican has the strength of mind or character or political position to tell the truth about healthcare. Instead, they’ll lie to both sides: they’ll say that they have brought the free market back, even as they say that they’ve ensured universality in health care coverage. Both cannot be simultaneously true. And while the American people do enjoy being lied to about health care, they don’t like it when reality demonstrates that lies remain lies, no matter who is telling them.