by Jon N. Hall 3/24/17
The structure and character of the federal government is largely the creation of Democrats. From Woodrow Wilson to FDR to LBJ to Barack Hussein Obama, every time progressive Democrats seize the presidency and Congress, they expand the size and scope of the central government. When Republicans recapture power, they are either unable or unwilling to roll back the Dems’ expansions. And so the New Deal, the Great Society, and quite likely Obamacare become permanent parts of government, and the Leviathan continues to grow.
Although Republicans have promised for years to “repeal and replace” Obamacare, since the March 7 unveiling of their replacement plan we see division in their ranks. The replacement plan is called the “American Health Care Act.” But let’s call it “Ryancare.” In its current form, Ryancare appears better than Obamacare, (that’s a low bar to clear). But Ryancare has some of the same problems as Obamacare. Herein are two tweaks to improve the bill.
One of the big pluses of Ryancare is that it ends the mandates. The employer mandate is a huge drag on the economy and the individual mandate may be fascistic. But the reason the hated mandates were part of the Obamacare is so insurance companies could accommodate “guaranteed issue” and “community rating,” which supposedly make it possible for “pre-existing conditions” to be covered. The idea was to enlarge the pool of policyholders with healthy young people so that the sickest among us could be paid for. Ryancare retains the two requirements: “Prohibit health insurers from denying coverage or charging more money to patients based on pre-existing conditions.”
Without the mandates, how’s that going to work?
One way for insurance companies to continue covering pre-existing conditions without the mandates for healthy people to buy health insurance is to raise premium prices, deductibles, copays, etc., of those who choose to buy insurance. Even under Obamacare, we’re seeing a rise in those costs. A better solution would be this: End the “guaranteed issue” and “community rating” requirements for private health insurance companies. That’s the first of the two tweaks.
Democrats are enamored of all things “comprehensive.” And so it is with Obamacare, which is a comprehensive makeover of the U.S. healthcare system. Not only did the new system intrude into business and people’s lives, it further intertwined the public and the private by creating a new entitlement: federal subsidies for the purchase of private health insurance. Unfortunately, Ryancare features a similar system: “Help Americans access affordable, quality health care by providing a monthly tax credit — between $2,000 and $14,000 a year — for low- and middle-income individuals and families who don’t receive insurance through work or a government program.”
Although Ryancare’s tax credit program would work differently than Obamacare’s subsidy program, it still amounts to a new entitlement; it’s still an open-ended draw on the treasury. And just like Obamacare, it involves the IRS. But here’s the thing: we already have a healthcare program for those who can’t afford to pay health insurance premiums; it’s called Medicaid. Rather than instituting another entitlement, Republicans might put those receiving Obamacare subsidies into Medicaid. But regardless of what Congress does about Obamacare’s subsidy enrollees: The proposed tax credit program should be dropped. And there’s your tweak number two.
Of course, some Obamacare subsidy users won’t like being thrown into Medicaid because not all doctors accept Medicaid. But if one can’t afford to pay the full price for something, including private health insurance, then one shouldn’t get it; one should have to settle for whatever charity is doling out, whether from private sources or the government. If Medicaid is a lousy system, well then fix Medicaid. But don’t create a whole new entitlement when the ones already on the books have serious problems.
Although there are things to like in Ryancare, it has retained two of the worst features of Obamacare, and neither feature is conservative. The tax credits are a new entitlement. And by retaining “pre-existing conditions,” Ryancare continues to treat the health insurance industry like a public utility or some government social safety net. Why not let businesses operate like businesses? Without the mandates, “guaranteed issue” and “community rating” are a prescription for higher premiums for everyone in an insurance pool.
The genius of Democrats is that they get folks addicted to “free stuff,” knowing that if the GOP even talks about taking it away, Republicans will be seen as Nazis. (But Obamacare is the fascist system, as it’s an intertwining of public and private. The decision in NFIB v. Sebelius, which put the Supreme Court’s seal of approval on the coercive individual mandate, should be seen in that light.)
The GOP is not the Santa Claus party, and may not be able to “win” on healthcare. Perhaps Republicans should look elsewhere for wins, such as getting the economy into a higher gear, tax reform, and balancing the budget. Congress is running a half-trillion-dollar deficit this year. I remember a time when Paul Ryan would warn folks about a looming “debt crisis.” Whatever happened to that guy?
Speaker Ryan has talked recently about the unique opportunity conservatives have to set the ship of state aright. But the grog with which he’s filling our tankards is Democrat Light, and it’s not even chilled. As currently configured, Ryancare won’t do much to roll back the Leviathan state.
Jon N. Hall is a programmer/analyst from Kansas City. • (960 views)