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Columns

The Real World of Obamacare Repeal

March 20, 2017 - 7:00am

The Lord giveth and the Lord taketh away, but for governments it's not that easy. Once something is given -- say, health insurance coverage to 20 million Americans -- you take it away at your peril. This is true for any government benefit, but especially for health care. There's a reason not one Western democracy with some system of national health care has ever abolished it.

The genius of the left is to keep enlarging the entitlement state by creating new giveaways that are politically impossible to repeal. For 20 years, Republicans railed against the New Deal. Yet, when they came back into office in 1953, Eisenhower didn't just keep Social Security, he expanded it.  

People hated Obamacare for its highhandedness, incompetence and cost. At the same time, its crafters took great care to create new beneficiaries and new expectations. Which makes repeal very complicated.

The Congressional Budget Office projects that, under Paul Ryan's Obamacare replacement bill, 24 million will lose insurance within 10 years, 14 million after the first year.

Granted, the number is highly suspect. CBO projects 18 million covered by the Obamacare exchanges in 2018. But the number today is about 10 million. That means the CBO estimate of those losing coverage is already about 8 million too high.

Nonetheless, there will be losers. And their stories will be plastered wall to wall across the media as sure as night follows day.

That scares GOP moderates. And yet the main resistance to Ryan comes from conservative members complaining that the bill is not ideologically pure enough. They mock it as Obamacare Lite.

For example, Ryan wants to ease the pain by phasing out Medicaid expansion through 2020. The conservative Republican Study Committee wants it done next year. This is crazy. For the sake of two years’ savings, why would you risk a political crash landing?

Moreover, the idea that you can eradicate Obamacare root and branch is fanciful. For all its catastrophic flaws, Obamacare changed expectations. Does any Republican propose returning to a time when you can be denied health insurance because of a pre-existing condition?

It's not just Donald Trump who ran on retaining this new, yes, entitlement. Everyone did. But it's very problematic. If people know that they can sign up for insurance after they get sick, the very idea of insurance is undermined. People won't sign up when healthy and the insurance companies will go broke.

So what do you do? Obamacare imposed a monetary fine if you didn't sign up, for which the Ryan bill substitutes another mechanism, less heavy-handed but still government-mandated.

The purists who insist upon entirely escaping the heavy hand of government are dreaming. The best you can hope for is to make it less intrusive and more rational, as in the Ryan plan's block-granting Medicaid.

Or instituting a more realistic age-rating system. Sixty-year-olds use six times as much health care as 20-year-olds, yet Obamacare decreed, entirely arbitrarily, that the former could be charged insurance premiums no more than three times that of the latter. The GOP bill changes the ratio from 3-to-1 to 5-to-1.

Premiums better reflecting risk constitute a major restoration of rationality. (It's how life insurance works.) Under Obamacare, the young were unwilling to be swindled and refused to sign up. Without their support, the whole system is thus headed into a death spiral of looming insolvency.

Rationality, however, has a price. The CBO has already predicted a massive increase in premiums for 60-year-olds. That's the headline.

There is no free lunch. GOP hard-liners must accept that Americans have become accustomed to some new health care benefits, just as moderates have to brace themselves for stories about the inevitable losers in any reform. That's the political price for fulfilling the seven-year promise of repealing and replacing Obamacare.

Unless, of course, you go the full Machiavelli and throw it all back on the Democrats. How? Republicans could forget about meeting the arcane requirements of "reconciliation" legislation (which requires only 51 votes in the Senate) and send the Senate a replacement bill loaded up with everything conservative -- including, tort reform and insurance competition across state lines. That would require 60 Senate votes. Let the Democrats filibuster it to death -- and take the blame when repeal-and-replace fails, Obamacare carries on and then collapses under its own weight.

Upside: You reap the backlash. Downside: You have to live with your conscience.    

     

Charles Krauthammer's email address is letters@charleskrauthammer.com.

(c) 2017, The Washington Post Writers Group

Comments

"the insurance companies will go broke." No worries there. The entire Congress is on the insurance industry payrolls. Healthcare will only be equitable in this country when the profit motive is removed, as has been done in every other industrialized country.

Those 20,000 without healthcare insurance are the very ones that caused the democrats to steal the healthcare from the private sector. It called I want everything for free syndrome. These are the very people that use the emergency room for all their aches and pains. The government needs to quit catering to them. They won't take a job because they know how to play the system. They carry will work for food signs and live under bridges and anywhere they can if they are rejected temporary from EBT and welfare.

Anonymous - lets hope one day you won't be in need health care. Its easy when you can provide for yourself, many can't and not because they are Lazy as the Right seems to think. The system is being gamed, but it on the top end of the spectrum. Its easy to blame it on those who can't defend themselves. I hope you never have to wear their shoes. Greed is the cause of this mess we're in, not the so call Free Loaders.

Don't repeal it, just edit it. Remove the first 24,000 pages and replace them with Rand Paul's 4-page Health Care Plan. Rand Paul is a doctor, and understands the health care problems and has a solution. Look it up and read it. You too will think this will work.

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