Avik Roy hits the nail squarely on the head during a discussion on repealing and replacing Obamacare with John Podhoretz and Peter Robinson.

[T]his is the problem with the failure of imagination of conservatism. It’s that we’ve conflated a policy outcome, more people having health insurance, with the process by which we achieve that outcome. And the point I’m trying to make is that we conservatives, we have always known that less government leads to more abundance, more wealth, more prosperity. We would never say we need more government so that every American can have a smartphone. We would never say we need government so that every American can have a job and yet we’ve accepted the left wing narrative that the only way to make sure that more people have the economic security of health insurance is through more statism. Why do we accept that narrative in healthcare when we accept it nowhere else in the economy? And this has been the failure of imagination of conservatism.

Why hasn’t Trump hired this guy?

RTWT

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. It’s not really a debate over Obamacare, it’s a debate over Medicaid. That’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 people’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 them—up to two-thirds, by some estimates—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: “[T]he program’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 don’t get the care they need.” 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 statist’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 Obamacare’s promoters knew about all along. Obamacare just boils down to an expansion of an old, existing, traditional government entitlement—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 can’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 doesn’t maximize federal support for the poor, nor does it fully adopt the free market…. 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. It’s a bill with no governing philosophy for a party and a president who have no governing philosophy.

Read the whole thing.

W. James Antle III reminds us that a complex, poorly understood national health care bill was already passed only to be repealed, decades ago.

Unlike President Obama’s recent health care handiwork, the 1988 law was a genuinely bipartisan achievement passed by lopsided margins. It was signed into law by a Republican president, Ronald Reagan. It offered all kinds of new benefits, including expanded coverage of hospital stays, at-home care, and prescription drugs (the act was in some respects of a forerunner of Medicare Part D).

The Medicare Catastrophic Coverage Act was nevertheless repealed a year later. No change in partisan control of Washington was necessary—the repeal was passed by a Democratic Congress and signed into law by another Republican president, George H.W. Bush. The repeal turned out to be most popular with the elderly voters who had demanded the new benefits in the first place.

Why? In addition to creating new benefits, the reform also imposed staggering new costs. Those costs fell most heavily on the senior citizens who were supposed to be the program’s biggest constituency. But, congressional Democrats were astonished to learn, many of these seniors were happy with their existing coverage and resented having to pay a new tax to fund this expansion of government—costs which kicked in before many of the benefits.

Sound familiar? The similarities don’t end there. Members of Congress also had to hear from angry mobs opposed to the legislation, otherwise known as their constituents. The most memorable such incident occurred on Aug. 17, 1989, when House Ways and Means Chairman Dan Rostenkowski (D-Ill.) held a meeting in his district to sell seniors on the benefits of the catastrophic coverage act.

Instead of being won over by their powerful congressman, the angry seniors waved protest signs and ran him out of the room. As Rostenkowski fled, they shouted “coward,” “recall,” and “impeach.” One elderly woman wearing heart-shaped glasses even threw herself on the hood of Rostenkowski’s car to keep him from leaving.

Rostenkowski got out of the car and tried to escape on foot. The crowd chased him for about a block before his driver came to whisk him away. Imagine what would be said if the Tea Party movement did something like that. Instead the protest was organized by one Jan Schakowsky, then director of the Illinois State Council of Senior Citizens, now a Democratic congresswoman and chief deputy whip for House Speaker Nancy Pelosi.

The protest made the national news and graced the front pages of newspapers. It also had its desired affect—the catastrophic coverage act was repealed within three months.

The 1988 legislative debacle did not resemble this year’s bill with respect to partisanship or initial public support. Democrats had no problem getting Republican votes, and the public was behind it.

However, 1988 does resemble 2010 with respect to the same kind of irresponsible drafting of a dreadfully large and complex bill that was voted into law without serious consideration of its costs and effects. It backfired then, and a lot of people would predict that the new health care bill will prove in practice similarly distressing to many of its intended beneficiaries.

Remember how the commentators on the left were predicting that the voters would change their minds and start liking Obamacare, once it was passed?

Rassmussen‘s latest poll demonstrates otherwise.

One week after the House of Representatives passed the health care plan proposed by President Obama and congressional Democrats, 54% of the nation’s likely voters still favor repealing the new law. The latest Rasmussen Reports national telephone survey shows that 42% oppose repeal.

Those figures are virtually unchanged from last week. They include 44% who Strongly Favor repeal and 34% who Strongly Oppose it.

Repeal is favored by 84% of Republicans and 59% of unaffiliated voters. Among white Democrats, 25% favor repeal, but only one percent (1%) of black Democrats share that view.

Only 17% of all voters believe the plan will achieve one of its primary goals and reduce the cost of health care. Most (55%) believe it will have the opposite affect and increase the cost of care.

Forty-nine percent (49%) believe the new law will reduce the quality of care. Sixty percent (60%) believe it will increase the federal budget deficit. Those numbers are consistent with expectations before the bill was passed.