On Wednesday, I quoted Philip Klein's column warning Republicans that it is now or never on Obamacare repeal, and calling this test of resolve in the face of political challenges a "gut check." Klein has since followed up with yet another gut check, this one directed at fellow conservative critics of Republican leadership's emerging proposal to repeal and replace much of the failing law. Klein's opposition to Obamacare is beyond reproach, and he's been a persistent detractor of suggested "repeal and replace" approaches that he regards (fairly or unfairly) as "Obamacare-lite." But he's also a pragmatist who understands political realities, so he's admonishing the right flank of the party on this issue -- with whom he agrees, in principle -- against derailing an imperfect plan that would nonetheless be far preferable to the crumbling status quo:
I certainly think conservatives should hold the line, and fight for as free market a plan as possible. But there is also a stark political reality. In the Senate, even using the reconciliation procedure and assuming Vice President Mike Pence breaks any tie, Republicans can only spare two votes. Looking at the range of plans that have been released, there is a Grand Canyon-sized gulf between Sens. Bill Cassidy and Susan Collins (who would keep Obamacare largely intact) and Sen. Rand Paul's deduction and health savings account-based plan. So, if anything is going to pass, there are going to have to be compromises. And at some point toward the end of the legislative process, conservatives will face a choice as to where they draw the line. An Obamacare Lite plan may still eliminate mandates, give states a lot more flexibility, while coming with less spending, lower taxes and fewer regulations. Though such a plan should not be confused as a pure free market alternative, would conservatives prefer that nothing happens and the full Obamacare stays intact, leaving Democrats with something substantial to build on when they retake power?
Klein compares conservatives' ultimate policy dilemma to lefties in Congress who eventually chose to advance the statist ball by voting in lockstep in favor of Obamacare's passage. That legislation fell fall short of their single payer dreams, but it was an important step toward that goal, so they made a strategic calculation to fall in line (even after their beloved "public option" was scrapped. "Conservatives are going to eventually find themselves in a similar spot — contemplating whether to support a plan they'd now consider Obamacare Lite in order to avoid preserving Obamacare Heavy," he concludes. On this point, Charles Krauthammer is practically begging the GOP to "pick a damn plan" and unite behind it. The fight against the Left on this issue is going to be tough enough. A divided Republican party simply cannot win that fight:
Precisely. The political facts on the ground are that Obamacare isn't working and remains unpopular. But people are also worried about another bout of major changes to healthcare policy, and while there's strong support for a massive overhaul of the current law (including rolling back big, hated provisions), most Americans believe that certain elements of Obamacare should be preserved in any replacement: Protecting people with pre-existing conditions, providing some form of assistance to obtain coverage, and allowing adult children to remain on their parents' plan until age 26. Any viable Republican plan must credibly satisfy these demands, which will inevitably lead to some policy prescriptions that fall well short of purely free-market solutions. That's just reality. By the same token, moderates who might prefer to tinker at the margins and pretend that they support "repeal" must realize that their party has won three of the last four national elections by promising to uproot this fatally flawed law. Just as conservatives will need to accept some compromises, so will anxious centrists. There are very few votes to spare, especially in the Senate. Therefore, a number of Republicans may have to choose between being principled purists (or hyper-cautious status quoers) and being responsible for guaranteeing the endurance of Obamacare's worst excesses, taxes, mandates, and market distortions.
I'll leave you with this explanation from Forbes' Avik Roy about why selling policies across state lines will drive costs down, and this piece from CATO's Michael Cannon offering an alternate take on pre-existing condition mandates. And in case you missed it the other day, read this data-driven analysis that helps refute the Left's go-to argument that Obamacare repeal would literally kill thousands of people:
"In reality, the best statistical estimate of the number of lives saved each year by the ACA is zero." https://t.co/Wm7M3fxjUa
— National Review (@NRO) February 27, 2017