The fight over the federal government’s role in health care is far from over. Republicans’ failure to pass a repeal and replace plan did nothing to change the fact that Obamacare is failing. What it did was raise the political stakes for when the inevitable crash happens.
First off, let’s put to bed any notion that Obamacare as it’s currently constituted can be fixed. Megan McCardle explains in Bloomberg View:
The only possible way to shore up Obamacare’s flawed design is through a big increase in subsidies for individual plans and bigger tax penalties for those who don’t participate. Democrats didn’t have the guts to do this, and they liked Obamacare. Ergo, Obamacare, as currently constituted, is not reparable as a political matter, no matter how easy the fixes may seem for those of us who do not have to get re-elected every few years.
Unfortunately, not even the Republican bill would have fixed these underlying policy or regulatory problems. That’s not because Speaker Paul Ryan didn’t do his homework, or that President Trump was impatient with the process, it’s because the playing field was stacked against Republicans.
Unlike when Democrats squeezed Obamacare through the Senate, Republicans don’t hold a filibuster-proof majority, which means that they had to abide by the “reconciliation” process. That allows legislation to pass with a bare majority, but it also means that all the provisions of the bill have to be related to the budget. That meant that Republicans could only prune back Obamacare’s excesses, not engage in the necessary process of ripping it up root and branch.
In that sliver of parliamentary daylight, Democrats saw their opportunity. They, just like everyone else, know that Obamacare is fundamentally broken and that the only realistic policy fixes are political nonstarters. They’ve been unable to do anything about it because to admit defeat would only serve to further hasten the demise of Obamacare (the fallout of which they would own forever) or give further political momentum to Republicans.
But obstruction proved far easier than governing. By refusing to do anything to clean up the health care mess they’d made, Democrats pushed GOP leadership into a corner. They had the political will and even the policy bona fides in their corner, what they didn’t have was a legislative path to a filibuster-proof vote.
Democrats knew that. And they also knew that this was their chance to get out from under the crushing weight of Obamacare’s failure. Charles Krauthammer explains on Fox News:
“The Democrats are going in one direction. When Obamacare explodes or collapses or ends with a whimper instead of a bang —but it’s going to expire one way or the other — the Democrats are going to head in one direction and one direction only; single payer. That’s the logic of Obamacare. It was a Jerry-built system which was going to temporarily create an entitlement but would not work because it was financially impossible. So it’s financially impossible, it collapses, but they have succeeded in creating an expectation of universal care . . .”
Right on cue, Sen. Bernie Sanders explained Sunday the flaws of the current system and his plan to introduce a single-payer health care plan to Congress.
“Deductibles are too high,” Sanders told CNN’s Dana Bash. “Premiums are too high. The cost of health care is going up at a much faster rate than it should.”
“Ideally, where we should be going is to join the rest of the industrialized world and guarantee health care to all people as a right,” Sanders continued. “I’m going to introduce a Medicare-for-all single payer program.”
This is a master stroke by Democrats. They simultaneously created the expectation of universal coverage at the same time they created reform legislation that was doomed to fail. Rather than own up to the disastrous state of their plan, they’re conveniently pivoting to their endgame: Single-payer. And let’s not forget Sen. Harry Reid’s comments in 2013 that presaged this reality.
“What we’ve done with Obamacare is have a step in the right direction, but we’re far from having something that’s going to work forever,” Reid told ‘Nevada Week in Review.
And when asked whether he meant whether Reid was hinting at abandoning private insurance as the means of accessing the health system, Reid said: “Yes, yes. Absolutely, yes.”
Republicans could have avoided this sneaky ploy if they could have gotten a repeal and replace plan over the finish line. Now they’ll have to work extra hard to prevent a real government takeover of the health care system.