There's a lot to like about the Better Care Reconciliation Act, the health-care bill unveiled last week by Senate Republicans. As drafted, the proposal preserves the most worthy features of the Affordable Care Act while addressing some of its key flaws.
This is, apparently, a controversial opinion.
Many critics on the right (like Rand Paul and Americans for Prosperity) decry the plan as some watered-down ObamaCare lite. Many liberals, meanwhile, have reflexively tarred Better Care as an unmitigated evil being foisted upon America by heartless Republicans.
Both sides are wrong. The Better Care act is better than you think.
The Senate health-care bill is obviously more thoughtful than the House's version, and not nearly as malign as many Democrats have summarily declared it to be. At first glance, it struck me as the kind of market-based plan conservative policy wonk Avik Roy, who once worked for Mitt Romney, would come up with if asked to replace ObamaCare. And on closer inspection, it is his plan, in key respects. That makes sense, given that Roy is the Republican Party's go-to expert on health-care policy. And considering the context, his influence on the bill is reassuring; when someone's expertise is undisputed, some degree of humanity can be safely inferred.
Many on the left would dispute that, at least in this case. "No tweaks by amendment can fix this monstrosity," tweeted Chris Murphy, the Democratic senator from Connecticut. "If you vote for this evil, intellectually bankrupt bill, it will ruin millions of lives." The bill's passage would, to be certain, have sweeping implications. But Republicans could make exactly the same normative claims about ObamaCare itself. They shouldn't, in my view; it's bad form to denounce people based on assumptions about their intent.
But if we're going down this path, let's at least be consistent about it: While the Affordable Care Act has surely helped millions of Americans, it has also still left millions of Americans uninsured, and many more with higher premiums and deductibles than they had in 2009, when Democrats promised that their plan would deliver precisely the opposite, among other things.
Even now, many Democrats are reluctant to acknowledge that ObamaCare's conservative critics were correct in predicting such problems, and that in some cases, at least, their objections were rooted in concern for the Americans who would be disproportionately affected by them, if so.
The left's default position is that ObamaCare's shortcomings are due to Republican obstructionism prior to its passage, and Republicans' subsequent refusal to cooperate. "I was careful to say again and again that while the Affordable Care Act represented a significant step forward for America, it was not perfect, nor could it be the end of our efforts," noted former President Obama in a statement criticizing the Senate health-care bill. He would, he added, be happy to support Republicans if they could just put together a plan demonstrably better than his, "that covers as many people at less cost."
So, single-payer, right? Nice. This is a discussion that Americans should have, at some point; I'm not convinced that it makes sense to think of health care as a market good in the first place. As it stands, however, that is how many Americans tend to think of it. And the Affordable Care Act, which passed in Congress without a single Republican vote, affirms the premise that we should think about health care this way: ObamaCare's key provisions are about the government's role in regulating, stabilizing, and expanding access to the market we already have, not in replacing it altogether.
The same is true of the Senate health-care bill, of course, and this brings us to a critical difference between the Better Care Reconciliation Act and the Affordable Care Act: The GOP's plan genuinely accepts the premise that Obama and the Democrats merely conceded, and seemingly resent. This would explain why Rand Paul and Co. are grousing that the proposal amounts to "ObamaCare lite" — a revision that would leave the Affordable Care Act's architecture and key regulations in place rather than smashing the law to rubble and lighting it on fire — and Democrats see it as a crime against humanity.
This also explains why there's a lot to like about the Better Care Reconciliation Act. It's a market-oriented plan that's serious about the trade-offs involved in such an approach. If you want to remove some bureaucratic hurdles and government largesse from the health-care market, as many conservatives do, then some people will lose coverage, and others will see an increase in their out-of-pocket costs. That's how markets work, even if the architects of ObamaCare refused to believe it.
And it's worth noting that Better Care is realistic, not nihlistic. Like ObamaCare, it recognizes that the government can and should play a role in situations where the market, if left to its own devices, has merciless implications. Most significantly, it largely preserves the protections the 2009 law established for Americans with pre-existing conditions, and provides reinsurance for the insurers who might have balked at doing so. That was a humane and worthwhile achievement which Democrats deserve credit for, even if they are heartless monsters who left millions of Americans uninsured.
It seems possible, as it stands, that none of this matters. On Monday, the Congressional Budget Office released its score of the bill, which found, among other things, that passage of the legislation would result in an additional 22 million Americans being uninsured in 2026, compared to projections based on the current law. The logic underlying this projection was debatable, but its political implications are clear cut. The Democrats who touted ObamaCare as a plan that would make comprehensive health insurance affordable to the average American are out of power, at the time being. But perhaps they will regain control of Congress in 2018. And if so, we can all look forward to seeing them unveil their secret plan.