According to the Republican leadership — Speaker of the House Paul Ryan (R-WI) and President Donald Trump in particular — last week marked a celebratory moment for conservatism. In particular, the House’s passage of the American Health Care Act (AHCA) marked two pieces of great news. First, the free market in health care had been saved from the depredations of leftist governance! Second, the free market will certainly not be allowed to run roughshod over those with preexisting conditions — the government will help them!
For most of my adult life, the Republican party has proclaimed to its supporters that it stands for free markets. Then, when the legislative process begins, the Republican party abandons its supposed free-market principles in favor of Democrat-lite policy. To bridge the gap, Republicans simply pretend that the latter is the former — they pretend that the government measures they embrace are actually free-market measures. So, for example, when it comes to the American Health Care Act, Ryan told Hugh Hewitt last week:
Either you believe in your principles, or you don’t. And our principles are we should have a free market in health care, a patient-centered system run by consumers. That’s why we have risk pools, tax credits and health savings accounts.
Now, it should be noted that state-created and state-sponsored risk pools are not “free-market measures.” If they were, then so were Obamacare exchanges. People are capable of collectively bargaining over health care — employers do it with insurance companies every day, and cooperative health arrangements such as religious health-care co-ops do the same. But state-run programs in which the state bargains on behalf of consumers using taxpayer subsidies are not free markets. They are subsidies to insurance companies.
Tax credits are also not free-market solutions. Handing $2,000 to someone who doesn’t pay that amount in income tax amounts to a back-door entitlement. And tax credits designated for particular ends desired by government are not indicative of free-market principles, either. They, too, are corporatist in nature. Government-induced health savings accounts might be preferable to paying higher taxes, but they are clearly a government-run form of social engineering.
Herein lies the problem.