It should come as no surprise to Townhall readers that the new Republican congress has no plan to deal intelligently with Obamacare. That’s unfortunate. The worst thing that can happen over the next two years is for president Obama to appear to take the high road – insuring the uninsured and fighting the mean insurance companies – while Republicans rail about the small and trivial parts of health reform.
And the worst thing that can happen is the very thing that is about to happen. So here is some unsolicited advice.
To begin with, Republicans in Congress have created their own internal gridlock on Obamacare. Even if the Democrats all abstained and let Republican legislators do whatever they wanted, the Republicans still could not agree on what to do next.
From the base there is the incessant cry for “repeal.” But as just about every Republican candidate in this last election acknowledged, there can be no “repeal” without “replace.” Otherwise, from 10 to 15 million people will lose their health insurance. However, “repeal and replace” means transitioning from Obamacare to a new system. And no matter how radically different the new system is, it will run the risk of being called “Obamacare lite.”
In fact, there isn’t a single Republican replace plan that hasn’t already been called “Obamacare lite.” And that’s before any negotiation with the other side takes place. Any repeal and replace agreement that has been negotiated with Democrats in Congress and with the White House will almost certainly be viewed with suspicious mistrust by the Republican rank and file.
Fortunately, there is a way out. In going forward, the GOP needs to make clear to its own base and to the Democrats that in any negotiation they will follow five simple rules.
Rule 1: No deviation from a simple vision. The Republican objective for the voting public should be: Keep your job; keep your health insurance; and keep your doctor. The most direct way to get rid of all the anti-job of Obamacare is to repeal the employer mandate. The most direct way to insure that people can keep insurance they like is to repeal the individual mandate. And the most direct way of insuring people can keep their doctor is to deregulate and denationalize the health insurance exchanges.
Rule 2: No backsliding. Negotiators rarely get everything they want. And whatever they get, Republican negotiators will be vulnerable to the charge that they are “helping Obamacare work better.” So here is the answer to that. Anything that leads to more job losses, more loss of insurance people want and more loss of doctors is off the table before anyone even enters the negotiating room. That is the line Republicans must not cross. Making health reform “work better” is okay so long as it moves us in the direction of the vision in Rule 1.
Rule 3: No separate deals for special interests. The reason Obamacare looks like a Rube Goldberg contraption is because it is almost purely the product of special interest bargaining. There are no principles like “justice or “fairness” that guide its content. Now that the impure deed has been done, however, we find that every single interest group wants to renege on its share of the burden.
Should we have a medical device tax? Probably not. Should labor union plans be taxed to subsidize health insurance for their non-union competitors? Absolutely not. Should hospitals have their charity care money restored? If we don’t we are going to be in serious trouble.
But remember why all those provisions are in the law. Special interests went behind closed doors and sold the rest of us out. Now they want to be relieved unilaterally from what they originally agreed to throw into the pot. That shouldn’t be allowed. They cooperated to give us mess that we are in, we need them now to cooperate to get us out of it.
So, nobody gets relief from Obamacare without helping and supporting the overall effort to reform it.
Rule 4. No provisions that produce pain with no gain. It is tempting for Republicans to try to block the system in place that subsidizes health insurance companies that are participating in the exchanges. These are provisions that protect the insurance companies against unexpected losses for the next three years. Some of the subsidies come from redistribution among the insurers themselves. But there is also an (apparently unlimited) taxpayer liability. Do you know anyone who wants to pay taxes to subsidize insurance companies? I don’t.
The problem is, this very same system of transition was adopted for Medicate Part D drug program by a Republican administration. And when Republicans were doing it, other Republicans didn’t complain.
Rule 5. No taking of political advantage, no matter how tempting. Yes, I know. The other side deserves all the political backlash it is getting. Had Barack Obama endorsed John McCain’s health plan, we would have had a better reform, a more workable reform and a more progressive reform than we now have.
But Democrats have already paid a heavy political price for that mistake. Voters elected Republicans this last time around because they want to move on.