Republicans can still fix health care. Here's how.

It's not over yet!

Paul Ryan
(Image credit: Mark Wilson / Getty Images)

What now?

That's the question everyone's asking after the GOP's humiliating health-care debacle. The answer from the White House and the Republican leadership in Congress? "Tax cuts!"

This is not good enough. President Trump and the Republican leadership need to remember that the Republican Party just spent seven years loudly promising to "repeal and replace" ObamaCare. Walking away now represents what the Washington Examiner's Philip Klein accurately called "the biggest broken promise in political history." As he notes, it's frequent for a politician to try and fail to accomplish something he said he would do. It's different, however, when an entire party and movement puts a promise at the top of its agenda for seven whole years, through several electoral cycles, and then just throws its hands up and walks away after an initial failure.

Subscribe to The Week

Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.


Sign up for The Week's Free Newsletters

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

Sign up

Trump's notion that now Democrats "own" the unraveling of ObamaCare is a complete fantasy. Trump has an atavistic need to shift blame, but the buck really stops at his desk. He has bent or broken many political laws during his astonishing rise in politics, but the one that still stands is that voters blame the guy in the White House when bad things happen. This is doubly true when they actually have good reason to blame him, which is the case here.

As many observers have pointed out, passing ObamaCare took a long time. Obama held town halls and rallies, campaigned over and over again for the bill, and was deeply involved in the legislative process and the policy details. The Republicans have not done this on the American Health Care Act, not even close. But they must. Trump certainly enjoys a good rally, and surely there must be someone the White House can find who can handle the process and the policy.

Often, health-care reform in the United States seems impossible. Conservatives, moderates, and progressives want seemingly incompatible things, and so do the voters who decide elections. Most voters' goal seems to be to essentially have everything for free, and not pay for it either at point of sale (the more conservative option) or through taxes (the more progressive option). Any ObamaCare reform bill has to get votes from both the Tea Party Freedom Caucus to pass the House, and enough Democratic senators to break a filibuster (since using the reconciliation process prevents a full ObamaCare repeal). It seems impossible.

And yet... The GOP today is like a man standing on the edge of a burning oil platform. Jumping into the sea will almost certainly kill him. But not jumping will definitely kill him. As daunting as the jump is, he has to jump.

So where should the GOP go from here? From the AHCA fiasco, there is actually a glimmer of hope. The conventional wisdom is that the Freedom Caucus sunk the AHCA because it spent too much money, but National Review's Reihan Salam has reported that the Freedom Caucus was actually open to the idea of using tax credits or other spending to finance health-care coverage for people, but wanted more ObamaCare regulations and mandates repealed in exchange.

This leaves open an option that has been endorsed by luminaries such as The New York Times' Ross Douthat and (ahem) myself, which would accomplish enough of everyone's goals to have a glimmer of hope of passage, and be good policy. It would involve auto-enrolling everyone in catastrophic health-care plans, a sure political winner ("From now on, no one in America will have to lose their house because they have cancer !" Trump can repeat over and over on the stump), radically decentralizing Medicaid (a necessity), directly funding health savings accounts for the poor, generally increasing the use of health savings accounts and nudging people away from employer-funded health insurance towards portable solutions, and many market-based regulatory reforms. Such a package would accomplish progressive goals of universal coverage and conservative goals of decentralizing health care.

It would be good policy and good politics. And it's actually doable! But not if Republicans have already given up.

Continue reading for free

We hope you're enjoying The Week's refreshingly open-minded journalism.

Subscribed to The Week? Register your account with the same email as your subscription.

Pascal-Emmanuel Gobry

Pascal-Emmanuel Gobry is a writer and fellow at the Ethics and Public Policy Center. His writing has appeared at Forbes, The Atlantic, First Things, Commentary Magazine, The Daily Beast, The Federalist, Quartz, and other places. He lives in Paris with his beloved wife and daughter.