Opinion

Republicans are about to walk into a buzzsaw of health care rage

They own health care now

For six straight years, Republicans have been fulminating against ObamaCare. They greeted its passage as the "death knell of freedom," in the words of former Pennsylvania senator and two-time Republican presidential candidate Rick Santorum. And since the Republican takeover of the House of Representatives in 2010, they have voted over 60 times to repeal the law in one way or another.

Now they have their chance to bring about the conservative health care utopia that they've been promising all this time. But some in the party are beginning to have second thoughts. President Trump said that he considered "doing nothing for two years," and blaming the ensuing chaos on Democrats. But that is a ludicrous evasion. Repeal or no repeal, the Republican Party now owns health care.

During the Obama presidency, Republicans got tremendous political mileage by exploiting the cracks in the antiquated American Constitution. The political structure it creates is designed to require compromise. But ordinary voters, whose grasp of anything about the Constitution is hazy at best, tend to simply blame the president when things aren't going well. So in times of divided government, that gives the party controlling Congress a strong incentive to refuse to compromise, so as to create gridlock and political chaos that will be laid at the president's doorstep.

That was the Republican strategy during the Obama presidency. They filibustered constantly, shut down the government to try to force the president to defund ObamaCare, and repeatedly threatened national default to try to extract spending cuts. That indeed created a lot of chaos, and harmed Democrats politically (while at the same time cratering the approval rating of the government as a whole).

But the shoe is on the other foot now. Donald Trump is president and Republicans control both houses of Congress, so there is no reason they couldn't get an ObamaCare replacement through. (If Democrats filibuster, the GOP could just abolish the filibuster.)

The problem, as myself and dozens of others have been pointing out for years, is that there is no possible policy framework that is better than ObamaCare while also more conservative. In fact, the most conservative "solution" here would be to just cut government provision of health insurance, as shown by the Heritage budget adopted by Trump, which gores Medicare and Medicaid in addition to ObamaCare. If passed, that budget would also kill tens if not hundreds of thousands of people, and drive millions into bankruptcy. That's what free markets do with medical treatment.

But that perspective is too brutal to state out loud for most people. It's also political suicide.

So more honest conservatives are beginning to realize that some sort of ObamaCare-esque policy is the inevitable endpoint. As American Enterprise Institute scholar James Capretta told Matt Lewis of his own health policy ideas: "You can look at this and say, 'Boy, doesn't this sound like the Affordable Care Act?' And the answer is 'yes.'"

This dilemma is beginning to dawn on some Republicans. As The Washington Post reported, a recent closed-door meeting of GOP lawmakers was rife with fear about their health care strategy. While some congressional Republicans are no doubt just scheming to come up with the best way to avoid being blamed for certain disaster if they repeal ObamaCare without an effective replacement, others seem to still have some shreds of empathy for their constituents. Tom MacArthur, a congressman from New Jersey, said in the meeting: "We're telling those people that we're not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them."

Republicans have taken extensive steps to protect themselves from the voting public, gerrymandering themselves a 7-point handicap in the House and attempting to stop liberals from voting with voter ID requirements and other dirty tricks. But the United States is still a quasi-democracy, for the moment at least, and Republicans are going to walk into a buzzsaw of rage if they repeal ObamaCare without offering something better.

But even if they don't, health care is still their problem. They've got the run of government, and every chance to fix ObamaCare's supposed problems, which they have been moaning about for years. Whatever problems persist — or new ones that are created — are now stapled to the Republican hide.

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