It's rarely fun to be a fiscal conservative in Washington, but this is an especially frustrating time. Congressional Republicans are working to pass a health-care bill that will leave the basic architecture of ObamaCare in place. Any concessions to moderates and Republicans from Medicaid expansion states will only preserve more of the law that GOP politicians have vowed to get rid of for seven years.
Most small-government types regard the stalled legislation as a subsidy-stuffed "ObamaCare lite" rather than a true free-market replacement. The various GOP proposals would offer a 2 percent cut in federal health-care spending at best. But nearly everyone else is describing the bill in apocalyptic terms, saying it will shred the social safety net and literally kill people.
Health care is rightly an emotional topic. And there is no question that many people benefit from ObamaCare. With an aging population, even modest spending cuts would have major consequences on the health coverage of millions.
It all goes to show you just how difficult it is to roll back any government program once it's in place.
This is true even with a law that has produced identifiable losers, such as the people in the ObamaCare exchanges who are enduring substantial increases in premiums or high deductibles that render their expensive insurance policies virtually useless, and who in many cases preferred the plans they had before the law was passed.
Why is it so hard to roll back even a flawed program? One reason is practical: Once people are given a government benefit, they will howl if you take it away. This is true in every aspect of life. Imagine that your company buys you lunch every Friday. You'll get used to it, even if the food is mediocre. If one day your boss realizes he's over budget and tries to cancel this benefit, workers will kick and scream because something is being taken away from them. It's only natural.
But there's more to it than that. In a way, the difficulty in shrinking government is also due to Democratic supporters of expanded government often getting the benefit of the doubt. They're trying to do good deeds! Their motives are assumed to be pure as snow, and their preferred policies are often judged by intentions as much as results.
Not so anyone who wants to cut spending or even control its rate of growth. "Tactics to get a good deed done are a lot different than tactics that hurt people just to help the wealthy," said Senate Minority Leader Chuck Schumer (D-N.Y.) in a rather revealing admission.
ObamaCare repeal will have real-world health consequences for the sick and the vulnerable that certainly must be discussed. But the specific "death tolls" being confidently predicted by politicians should be subject to far more skepticism and scrutiny than we've seen so far. The 2016 Democratic presidential nominee Hillary Clinton is able to call Republicans the "death party" without attracting the eye-rolling chyrons that often greet President Trump's hyperbole.
The data concerning ObamaCare's actual impact on U.S. life expectancies tends not to go as viral. Neither does research questioning whether Medicaid, expanded under ObamaCare and a major sticking point in the Republican bill, produces better health-care outcomes for its beneficiaries than going without health insurance at all.
Occasionally, government programs do get cut back. Welfare reform ended an entitlement after more than a decade of bipartisan concern that the existing policies were failing (and thanks to a critical mass of voters who believed that non-working people did not deserve high levels of government support). The Medicare catastrophic coverage plan had front-loaded costs with benefits to come later, prompting its swift bipartisan repeal.
But this isn't the norm. And the headwinds Republicans are facing as they try to even partially repeal ObamaCare is more typical of the obstacles government-cutters usually face. It gets even more challenging now that the party is led by a president who is not committed to constitutionally limited government and agrees with critics that the legislation is "mean." Plus, Republicans have not made any kind of systematic case for an alternative health-care policy vision, so they are trying to beat something with nothing.
None of this is to say that the concerns people are raising about the risks of curtailing any part of ObamaCare aren't valid. They are in fact an important part of the debate. But there is a word that describes countries where the benefits of government policies can be widely discussed, or even assumed without evidence, but any focus on the costs is mean: broke.