The response to Senators Ted Cruz, Rand Paul, Ron Johnson, and Mike Lee’s statement over “Obamacare Light” or Better Care Reconciliation Act of 2017 or McConnellcare or whatever you want to call it has been cynical, at best. AP suggested it was just “kabuki theater,” while The Dallas Morning News pointed out Cruz appears to be trying to get a few more conservative goodies. AP also looked at the idea Paul and others were trying to do “Denounce and Preserve,” to make sure they’d be re-elected in future. It’s a theory suggested by The Atlantic’s David Frum because he believes Tea Party senators, specifically Paul, are in a Catch-22: they may not support Obamacare, but their constituents are okay with some of the results.
Paul also represents a state that has done well out of the Affordable Care Act. Four hundred and forty thousand Kentuckians have gained coverage under the ACA; Kentucky’s uninsured rate tumbled from 20 percent in 2013 to 7.5 percent in 2015.
Even more strikingly, it is Kentucky’s Appalachian Southeast that has seen the biggest gains from the ACA. And it so happens that southeastern Kentucky voted more staunchly for Paul’s 2016 reelection than did any other section of the state.
Paul won 76.6 percent of the vote in Clay County, where 15.6 percent of the total population has gained coverage via the ACA’s Medicaid expansion. He won 81.5 percent of the vote in Jackson County, where 15.1 percent owe their Medicaid to the ACA. He won 84 percent in Leslie County, where 18 percent would lose Medicaid if Obamacare were repealed.
Frum’s theory is Paul is an ideologue, but also a pragmatist who knows what he wants is pretty impossible so…do a moral victory.
Paul’s demand—repeal the ACA and replace it at the same time, even the same day—is obviously unworkable, even aside from the need to rally sufficient votes in the Senate to overcome a Democratic filibuster. You have to imagine that he and other self-imagined purists appreciate that.
But what is workable is a more familiar play: to strike a heroic attitude of principle while in fact supporting as the least-bad option a law that you nominally oppose. Bob Dole famously advised that the safest position for a politician is to “support the bill that failed; oppose the bill that passed.” One doubts that Rand Paul will be the only Republican to recognize the advantages of denounce-and-preserve over repeal-and-replace.
Frum certainly knows more about the inner working of politics than I ever will, but he’s unfortunately blinded by the notion of pragmatism. Yes, Ronald Reagan famously had the “half a loaf is better than none,” quote, but at what point does pragmatism go too far? There is something to be said about compromise, but there is also something to be said about sticking to one’s guns, especially when it comes to freedom and liberty.
It appears most conservative and libertarian groups are hoping the Senate health care bill will be modified even further. FreedomWorks called the bill, “an amendment to Obamacare,” while backing Cruz, Paul, Lee, and Johnson in their statement on amendments. Heritage Foundation went a step further and suggested the Senate needed to make more changes to the Medicaid formula and more waivers for states. Heritage could be seen as falling in line with Frum’s theory of pragmatism, while FreedomWorks is pushing for more changes. They’re also trying to make sure McConnell and other Senate Republicans keep their promise of repealing the health care law, which isn’t a bad thing.
But how do you repeal Obamacare, and what sort of health system is put in place? Is it better to kill the law through a thousand cuts, or do one’s best imitation of Thor wielding Mjolnir and bash the thing into a bazillion pieces?
This goes back to Frum’s theory of pragmatism and “denounce and preserve.” It takes a spine and a strong set of beliefs to withstand the pressures of government, especially one which is squeezing even tighter personal liberty and free markets. The theory of “getting what you can because you can’t get what you want,” is certainly strong with governmental types, whether they be politician or analyst. It’s easy to become a cynic in politics, especially when one knows the forces aligned against you (whether it be special interests or parties or what have you).
But there is something to be said about idealism and fighting for what you believe, especially when it comes to free markets and liberty for all. It’s possible the best way to do this is slowly expand freedom where you can, which was Michigan Congressman Justin Amash’s defense of his support of the House bill. This could be why piecemeal destruction of Obamacare may be better than one big Norse hammer. It just depends on what’s being modified. If the GOP wants to pass a health care law which leaves most of Obamacare intact, with slight changes, then it shouldn’t be supported. If the GOP wants to do something similar to Paul’s proposal from January, which is imperfect but better than the current bills, then that should probably be what the GOP considers.
It’s also possible cash-only doctors become even more and more of an option for patients to seek treatment. This would further weaken the current health care system, while making sure patients are still able to get medical treatment. It would be difficult for some diseases and illnesses (like cancer, brain surgery, and lung disease), but there are already cash-only options for heart disease and broken bones. It would be interesting to see what happens if a hospital ever decided to go cash-only, if it’s even possible given the standards federal and state government put on them.
One thing I’ve learned is the fact that fixing America’s health care system isn’t going to happen overnight or in my lifetime. There are multiple government programs and court or board rulings which need to be done away with before a truly free market health system will come about. A health system where there is better oversight by patients, physicians, and hospitals on medicine. But that’s thinking long term in a country which typically thinks short term, especially when it comes to individual needs. It also means sticking to one’s ideals, while also being willing to compromise as long as freedom is increased. That’s not being pragmatic; that’s being idealistic and honest.
There are steps the GOP can take to do away with Obamacare while pushing for even more free market medicine. Paul’s bill is probably the best first step, and it deserves a hearing and vote in the Senate. The one released by Senate leadership should probably just be done away with completely. Opposing it isn’t necessarily “denounce and preserve,” especially when a better bill can come about.