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Second of Four Parts…
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The Republicans Face Flak
The fate of Obamacare dominates the news—again. Eight years ago, anti-Obamacare Republicans and Tea Partiers were on the offensive. Today, it’s pro-Obamacare Democrats, perhaps joined by “astroturf” activists, on the offense.
In the first installment of this series, we looked at the hot political issue of pharma drug prices. Now we’ll look at an even hotter political issue, the fate of Obamacare—and we’ll also see how it ties into the question of pharma drugs.
As Republicans grapple with Obamacare, the Main Stream Media headlines are, well, daunting. For example:
The New York Times, February 2, “GOP Campaign to Repeal Obamacare Stalls on the Details.”
CNN, February 13, “Republican lawmakers grow wary of ‘town hall’ events.”
The same day, Politico bannered this headline, too: “Doubts grow that GOP can repeal Obamacare.”
The Wall Street Journal, February 18, “Trump Agenda Is Beset by Opposition on Many Fronts.”
The Washington Post, February 19, “The prospects of a quick Obamacare repeal are sinking fast.”
You get the idea. And below the level of headlines, some of the texture might be unnerving to some—especially voters. In another New York Times story published on the 13th, Rep. James Sensenbrenner (R-WI) was quoted as telling a town hall in his suburban Milwaukee district:
It’s kind of like, you know, getting a 30,000-piece jigsaw puzzle for Christmas, and, you know, cleaning off the dining room table and seeing how long it takes to put all the 30,000 pieces together in the right place. It’s not going to be easy.
A 30,000-piece jigsaw puzzle? Has anyone, in the history of the universe, had an easy time putting one of those together? So what does that say about prospects for a smooth overhaul of Obamacare?
Whoa! Wait a second, the reader might protest: Those are all MSM articles. Of course, the MSM wants us to believe that Republicans are ineffectual and heartless, all at the same time. So are all those headlines skewed, maybe even “fake news”?
Maybe. Yet if that’s the case, then why are news items from the right not much better? On February 20, The Drudge Report blazed the headline, “Prospects of quick Obamacare repeal sinking fast.” And the next day, the 21st, a Drudge header was even more emphatic: “CONGRESS STALLS TRUMP AGENDA.”
Also from the right, Christopher Jacobs, writing for The Federalist on February 21, declared that the House Republican plan, as outlined in advance of actual legislation, was “a great disappointment.”
That same day, Sen. Rand Paul (R-Kentucky), the leading champion of libertarianism in Congress, was blunt:
My worry now is that many people are talking about a partial repeal of Obamacare. If you only repeal part of it and you leave some sort of Obamacare light, which some are talking about, my fear is the situation actually gets worse.
There’s a phrase: “Obamacare light.” And whether one sees that as an insult or a compliment, that does seem to be where Republicans are headed. Rep. Greg Walden (R-OR), the influential chairman of the House Energy and Commerce Committee, offered this cautious take on Obamacare’s possible future:
There are some of these provisions in the law that probably will stay, or we may modify them, but we’re going to fix things, we’re going to repair things.
Such incrementalist talk will no doubt infuriate many among the activist Republican base, but most GOP officeholders seem to be looking at bigger numbers—such as the national polls. And those polls show that only about a fifth or less of Americans support immediate repeal.
For example, a Kaiser Family Foundation poll from early January found that 47 percent of Americans want to keep Obamacare, 28 percent want to see it repealed only when a replacement plan is firmly in place—and just 20 percent want to see it repealed immediately. And a more recent Quinnipiac Poll found that support for immediate repeal is actually declining.
To put a Republican name next to these numbers, we might consider Rep. Tom McClintock, who for the last eight years has represented a district in north-central California. McClintock seems to have a safe seat, and yet as The Sacramento Bee notes, 47,000 people in his district now have health insurance thanks to a single provision of Obamacare, the expansion of Medicaid. We might observe that it’s the rare politician who wishes to antagonize so many potential voters, especially when the Democrats stand ready to contact and mobilize each and every one of them.
Thus McClintock has urged caution on his colleagues. As he told the assembled House Republicans at their recent retreat in Philadelphia, if they alter Obamacare, “Republicans will own that, lock, stock, and barrel.” In other words, for better or for worse, they will bear full responsibility for the American healthcare system.
Meanwhile, on Fox News, Charles Krauthammer made the same point:
The problem is that if you get it done, you own the entire system of American medicine. . . . If you replace, you are going to have to redo all of American medicine all over again, and then you become responsible. . . . So if something goes wrong in anybody’s life—denied coverage, lousy coverage, no available doctor, premiums increasing, whatever it is—whether or not it is caused by the replacement bill, you will be responsible for it and blamed.
In the meantime, the Democrats and the left are, indeed, turning up the heat. So should Republicans be worried? Some observers say yes.
On February 14, Jim VandeHei and David Nather, writing for the buzzy Beltway publication Axios, observed that some 147 million Americans benefit from government-backed health programs, such as Medicare, Medicaid, and VA benefits. The Democratic strategy, they added, is to scare all these beneficiaries about Obamacare repeal. That is, lump them all together and message them so that they all feel threatened. Will it work? We’ll have to wait to find out, of course, but here’s how the Axios scribblers see it in the meantime:
This year’s version of “government takeover” is “throwing 20 million people off of health insurance.” Democrats have been throwing that line around, even though Republicans are trying to find a replacement plan that covers people in other ways. (Their problem: They can’t guarantee it will cover all 20 million.)
Continuing, the two write:
Democrats in Congress are under direct orders from party leaders to crank up their own protests, to build on the loud and angry demonstrations at Republican town halls. And there is every reason to believe they will be highly effective. How do we know? Because Republicans exploited the same fears, energy and trends to do unto Democrats as Democrats are about to do unto them. [emphasis added]
Again, no one is an all-seeing oracle, but just on February 21, in the early days of Resistance Recess, came some indicators. One was this New York Times headline, surveying the activist activity surrounding Republican lawmakers’ meetings in Iowa and around the country: “Republicans Return to Town Halls, and Protesters Follow.” And this, from Politico: “This time, [Sen. Chuck] Grassley hears pro-Obamacare voices: The Iowa senator’s 2009 town halls helped kill bipartisanship for the health law. Now, the crowds worry about repeal.”
Once again we might ask: Is all this noise simply journalistic hype?
We’ll have a better handle on that question this spring, when Georgians go to the polls to fill the vacancy in the 6th Congressional district left by the departure of Tom Price, now Secretary of Health and Human Services. Price himself handily won re-election to the House last year, but Trump won the district by just a single percentage point. And so, of course, the Democrats will seek to make the voting a referendum on Trump, not Price.
The balloting takes place on April 18, and, if needed, a runoff will be held on June 20. In the meantime, we can observe that special elections are typically low-turnout affairs, with the advantage going to the side that can bring out the most “mad as hell” voters. So Peach State Republicans will have to get themselves energized to keep the seat.
Moreover, looking beyond that special election, we can see that the precise details of the Republicans’ repeal/replace/repair legislation will be vital to their fortunes in the 2018 midterms. So if we recall Rep. Sensenbrenner’s jigsaw puzzle analogy, we know that each tiny detail of the GOP plan will be critical.
We might further observe that it’s the American middle class that finds itself right smack in the middle of the Obamacare fight. And why is that? It’s because the rich and the upper-middle-class have all the insurance, and the money, that they need. And the poor already have Medicaid and charity. So that leaves the middle class at the mercy of the health-insurance tides.
Veteran health observer Robert Laszewski, a frequent critic of Obamacare, offers these words of warning to the GOP and, in particular, to the Trump coalition:
If you take Obamacare as it looks right now, [about half of enrollees] don’t get a subsidy because their incomes are too high. They make $90,000 or $100,000 a year but are in the individual market. These tend to be Trump supporters. So if [the administration’s forthcoming legislation] further destabilizes this thing and there are 20-to-50-percent rate increases, he’ll be screwing his own people.
Stepping back and surveying the situation, Chris Krueger, a Republican Capitol Hill veteran, now penning an influential newsletter for investors, observed on February 14:
The GOP is completely wrapped around the axle on ObamaCare and has shifted their messaging from “repeal” to “replace” to “repair.” This is a legislative Vietnam and it is going to take a while to find an exit strategy.
Yikes! Does the Republican healthcare effort resemble, even metaphorically, the disastrous US quagmire in Vietnam? Or is that just one man’s opinion? We’ll have to see. And it’s worth noting, of course, that no actual legislation has emerged. So we shouldn’t rush to judgment, even if the MSM wants us to.
And yet, probably even the most optimistic Republican has to admit that Obamacare has proven to be a thornier issue than the GOP first thought.
So some might be inspired to ask: What, exactly, have Congressional Republicans been doing for the past seven years? Yes, it was on March 23, 2010, that Barack Obama signed the Patient Protection and Affordable Care Act, and so Republicans have had plenty of time to think through their preferred alternative.
The Bottom-Line Question of Health Insurance
So what’s been the hang-up on the Obamacare rethink? Part of the answer is that the GOP has never really come to grips with the basic question: Do Americans have a right to health insurance?
For some on the edges of American politics, the answer is simple: “No,” or, even, “Hell no.” The 2016 Libertarian Party platform, for example, is forthright in expressing that opinion:
We favor a free-market health care system. We recognize the freedom of individuals to determine the level of health insurance they want (if any).
Without a doubt, that’s an honest viewpoint. The problem for the Libertarians is that it’s not a widely held viewpoint; we might recall that the Libertarian presidential candidate last year, Gary Johnson, won 3.2 percent of the vote.
Meanwhile, Republicans, striving, as always, for actual majorities, have a more complex task: They must uphold Republican ideals of liberty and limited government, while at the same time keeping faith with the basic needs of American citizens.
Perhaps the most articulate champion of most Republicans’ thinking on healthcare is Sen. Ted Cruz of Texas. In his February 7 debate on CNN with Sen. Bernie Sanders, Cruz was a veritable machine gun of facts and figures, perforating the foibles of Obamacare. Hands down, Cruz won the debate on points.
Yet for his part, Sanders, in his dogmatically dogged way, had a powerful point of his own to make that night: People need health insurance. And so when a woman in the audience, one Neosho Ponder, a breast cancer survivor, told both Senators that she was worried about losing her healthcare without Obamacare, Sanders flashed a look of triumph.
Yet Cruz, fast on his feet as always, had a solid response: Republicans, he said, support prohibiting insurance companies from canceling coverage. And the Texan added that GOP proposals would “prohibit companies from jacking up the insurance rates because [people] got sick or injured.”
That was a good answer that seemed to satisfy the questioner, but now we are reminded of just how complicated the Republican repeal/replace/repair agenda will be. That is, how do we maximize freedom while at the same time guaranteeing coverage—and at reasonable prices? To be sure, there are answers to these questions, but they are complex answers. So the GOP will need Cruz-like lucidity to make their case to the American public.
As an aside, we might also note that Cruz has a second arrow in his healthcare quiver: the idea of medical cures. In that same February 7 debate, Cruz made the case for reform of the Food and Drug Administration, as well as other steps needed to spur medical innovation. As he said:
The four most devastating diseases in terms of human life and dollars [are] heart disease, Alzheimer’s, diabetes and cancer. We ought to be investing everything we can to cure those diseases. Just curing cancer, an incredible achievement, would save $50 trillion and countless lives across the globe.
So yes, Cruz has a point there, too. And yet as we all know, in 2017 the big healthcare fight will be over Obamacare.
So now we come to another dilemma of the health insurance debate, which is actually a kind of cosmic joke. And that is this: For the epic fight over Obamacare, pro and con, it’s a fact that today, after seven years of national health insurance, more than 28 million Americans do not have health insurance.
So we can see: For all the vast ambition of Obamacare’s conception, for all the political perdition suffered by Democratic politicians in the midterm elections, and for all the heavy-handedness of its actual implementation, Obamacare has not achieved its mission. It would seem that the American people will simply not sit still long enough to be enumerated by Uncle Sam.
Thus we might conclude that the dream of universal coverage is just that: a dream. That is, the goal of covering 100 percent of the population has become a kind of theology—and on earth at least, theologies are impossible to prove.
Indeed, as Republican health-policy veterans Tevi Troy and Lanhee Chen argued in The Washington Post on February 2, it might be best for Republicans to think of fresh ways to move toward the Obama goal of coverage—such as, for example, new kinds of tax credits—even as they recognize that perfection can be found only in a higher realm.
So now, down here on earth, we are starting to see the likely outcome of Republican healthcare efforts this year: Obamacare will go away, but the replacement will have unmistakable traces of, um, the Affordable Care Act.
That’s a solution that won’t please purists on either side, but as they say in DC, a good legislative product might not be a work of art, but it can be artful work.
Yet still, for all the storm and stress over health insurance, the point that Cruz makes about the cost of disease, and the value of cures, is worth bearing in mind. After all, health insurance is only as good as the health system backing it up. If an American is diagnosed with, say, pancreatic cancer, there’s an 80 percent likelihood that he or she will be dead within a year, health insurance or no health insurance. And if an American is diagnosed with Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis), he or she is likely to need years, even decades, of costly care.
So once again, health insurance, by itself, is no answer to the human and financial cost of death and disability. The goal of human health requires professional caregivers and the best technology; financial mechanisms can play no more than a supporting role.
And so we come back to the issue of actual health, which we touched upon in the previous installment. Actual medicine offers the best and easiest hope for relief from horrible illnesses. And medicine is ultimately cheaper, too, because good health is less expensive than illness.
We’ll return to this topic, and to pharmaceutical drugs, in the next installment.