Charles Krauthammer: The real world of Obamacare repeal


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 year’s 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.

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



Reader Comments ...


Next Up in Opinion

Opinion: Is America up for a second Cold War?

After the 19th national congress of the Chinese Communist Party in October, one may discern Premier Xi Jinping’s vision of the emerging New World Order. By 2049, the centennial of the triumph of Communist Revolution, China shall have become the first power on earth. Her occupation and humiliation by the West and Japan in the 19th and 20th centuries...
Because Sarah sez so, that’s why

When White House press secretary Sarah Huckabee Sanders asked the press corps Monday to preface their daily briefing questions with a statement of thankfulness, reporters obliged. Or, should we say, obeyed. For this, no doubt, Sanders was grateful. Yet again, she controlled the crowd, though this time by candy-coating her usual condescension with faux...
Editorial cartoon
Editorial cartoon

CARTOON VIEW MIKE SMITH
War on sexual predators might be different under President Hillary

Would the war against preying on women be blazing so fiercely had Hillary Clinton been elected? When I interviewed women in Hollywood about the ugly Harvey Weinstein revelations in The Times and The New Yorker, they told me that feelings of frustration and disgust at having an accused predator in the White House instead of the first female president...
This Thanksgiving, here are 5 myths about American Indians
This Thanksgiving, here are 5 myths about American Indians

Thanksgiving recalls for many people a meal between European colonists and indigenous Americans that we have invested with all the symbolism we can muster. But the new arrivals who sat down to share venison with some of America's original inhabitants relied on a raft of misconceptions that began as early as the 1500s, when Europeans produced fanciful...
More Stories