Robert Tracinski explains why repealing Obamacare is such an uphill battle. When you replace Conservatism with Populist Nationalism, you’re lacking the necessary conviction to oppose the Welfare State.
If you want to know why Republicans have bogged down, notice one peculiar thing about the Obamacare debate so far. Itâ€™s not really a debate over Obamacare, itâ€™s a debate over Medicaid. Thatâ€™s because Obamacare mostly turned out to be a big expansion of Medicaid. The health insurance exchanges that were supposed to provide affordable private health insurance (under a government aegis) never really delivered. They were launched in a state of chaos and incompetence, and ended up mostly offering plans that are expensive yet still have high deductibles. Rather than massively expanding the number of people with private insurance, a lot of the effect of Obamacare was to wreck peopleâ€™s existing health care plans and push them into new exchange plans.
Ah, but what about all those people the Democrats are claiming were newly covered under Obamacare? A lot of themâ€”up to two-thirds, by some estimatesâ€”are people who were made newly eligible for a government health-care entitlement, Medicaid. But shoving people onto Medicaid is not exactly a great achievement, since it is widely acknowledged to be a lousy program.
Conservative health care wonk Avik Roy explains why: â€œ[T]he programâ€™s dysfunctional 1965 design makes it impossible for states to manage their Medicaid budgets without ratcheting down what they pay doctors to care for Medicaid enrollees. That, in turn, has led many doctors to stop accepting Medicaid patients, such that Medicaid enrollees donâ€™t get the care they need.â€ Partly as a result, a test in Oregon found no difference in health outcomes between those with access to Medicaid and those without.
Then again, a massive expansion of Medicaid fits perfectly with the preferences of the welfare statistâ€™s boosters: lousy free stuff from the government is better than good stuff you pay for yourself.
Yet notice this hits a big Republican weak spot, one I suspect Obamacareâ€™s promoters knew about all along. Obamacare just boils down to an expansion of an old, existing, traditional government entitlementâ€”and Republicans are lousy at rolling back traditional entitlements. …
Democrats create new entitlements, then Republicans reform them. Democrats get all the credit for showering us with benefits, and Republicans accept the role of the mean-spirited accountants who tell us we just canâ€™t afford it. …
[As to the existing bill:] Pradheep Shanker sums it up nicely when he describes the Obamacare replacement bill as a piece of legislation with no ideological point of view.
My biggest complaint about this bill is that there really is no governing philosophy in its writing. It neither pleases conservatives nor moderates. It makes half measures to increasing patient choice, but retains taxes such as the Cadillac tax, while at the same time maintaining the employer based health insurance system. It doesnâ€™t maximize federal support for the poor, nor does it fully adopt the free marketâ€¦. The muddle created by the GOP here makes it very difficult to make a sound, concise argument regarding specifically what their goal is.
That makes sense, in a way. Itâ€™s a bill with no governing philosophy for a party and a president who have no governing philosophy.
Read the whole thing.