Health Care and We, The People

Posted: Mar 28, 2017 12:01 AM
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The Obamacare debacle -- we might as well call it by its right name -- underscores an abiding truth about democratic politics; to wit, politicians rarely get anything important done. Theirs, save on rare occasions, is the wrong forum for doing important things.

In politics, you work with open minds and closed minds and reprobates and time-servers, along with the occasional statesman or patriot: the whole assemblage representing a hundred different points of view -- or no point of view at all. You work to scrape together consensus. Sometimes you succeed, especially on smaller matters. Just as often you fail, especially on larger matters: health care reform, for instance.

The momentary vogue, in assessing the collapse of House hopes for repealing and replacing Obamacare, is to blame Speaker Paul Ryan or President Donald Trump or cynical Democrats or the House Freedom Caucus; when, in fact, the job was and is a mind-bender. Too many varied and clashing interests must first be reconciled, starting with the interest of those now enrolled in this jerry-built and hyper-costly program. Taking things away from people, even when you propose giving them something else (e.g., tax credits, as in the House bill), is harder by far than giving it to them in the first place. People -- also known as voters -- relish familiarity. Rip something from our grasp, and you got some 'splaining to do, congressman.

"Repeal and replace Obamacare" made a nice campaign sound bite, not least because of the alliteration. How do you do it, though, once government-sponsored insurance has become part of the living-room furniture?

The House bill overseen by Speaker Ryan -- a brilliant and immensely decent public servant -- was no one's idea even of a partial replacement. The Wall Street Journal's editorial page, to which there is no equal for lucid conservative commentary, saw passage of the bill as, on balance, easily preferable to defeat. The House's production was a start. It saved money and expanded personal rights. You could build on it.

Well, no, you couldn't, as the House's conservative Freedom Caucus saw the matter. The bill left too much of Obamacare's timberwork in place.

Wait, though -- it should have left even more of the structure, complained congressmen fearful of voters who might see their health care programs as compromised under the House bill.

And so the whole enterprise of repeal and replace became a case of "Durned if you did; durned if you didn't": just the way things go in democratic politics, when too many people want too many different things.

Obamacare, in its place and time, proved to be one of those rare big things that politicians accomplish: a big, bad thing, to be sure; heavy on regimentation, central direction and irresponsible finance. The Capitol Hill Mob at the time -- meaning a generally united Democratic Party, eager to perform for the new Democratic president -- put the thing through, using brass knuckles, blackjacks and veiled reminders to the resistant that it sure would be sad to see a nice guy lose his seat.

Republicans, a breed of cat with a different neurological makeup, never achieved during the repeal effort this level of Edward G. Robinson-esque, shall we say, persuasion. They pointed fingers but never pointed gats (of the metaphorical -- and highly effective -- sort).

None of which is to say that Obamacare is with us now and always. As Republicans like to point out, in a third of American counties, you only have one insurance provider to choose from. We already knew you couldn't keep the doctor you liked.

Democrats will, in time, start calling for tax increases to prop up the system. Republicans may at some point -- not a distant one, we may hope -- rise to the occasion and do what they should have done last week: Start reforming.

Last week would have been easily a better time for it than five, maybe 10, years from now. But politics reigns! The blame for that sad condition does not fall entirely on House speakers and presidents. Those who tell politicians, "Gimme! Gimme! Gimme!" and won't take no for an answer, even when they know better: such are the main culprits. Of whom there seem currently to be around 300 million.

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