The Obama administration is protecting a small lead late in the game with the ball deep in their own territory. Some coaches would punt and gamble that the defense will protect the lead and win the game. The president has decided to put the backup quarterback in and play offense. Bill Clinton is going to be the public face of Obamacare in the waning minutes.
Without torturing the sports analogy any further, it is important to understand that the game ends in January 2014. Once the subsidies start, Obamacare will have beneficiaries and beneficiaries support repair, not repeal.
Bill Clinton is not a force to be trifled with. He will aggressively promote Obamacare as a trinity of compassion, health security and fiscal prudence. The degree of success he achieves will depend largely whether the Republicans mount a coherent, unified and energetic counterargument. I wish I could say I’m filled with confidence. The most articulate conservative voices opposing Obamacare are not republican politicians. Sally Pipes, John Goodman and Thomas Sowell have spoken very eloquently against the ACA, but none have the political cache’ of President Clinton.
A few observations; the very fact that President Obamacare would entrust this effort to Bill Clinton indicates that Obama himself believes that the ACA is vulnerable. He had to grit his teeth and swallow hard. The president has no shortage of self-esteem and he wouldn’t go there if it wasn’t necessary. Second, any republican effort must be a unified one. If we can’t find common ground here, the ACA will live forever. Entitlement programs do not fall of their own weight. They become insolvent but they don’t go out of existence. They live on in a perpetual state of reorganization and refinancing.
All of Mr. Clinton’s talking points can be refuted. Health security is mostly a function of medical care. We do a pretty good job of delivering medical care to the poor without an insurance mandate. Free and heavily subsidized care is understandably somewhat restricted and inconvenient; but free, convenient and unrestricted is not really a desirable outcome. The demand for free and convenient would be astronomical.
Costs do not disappear when services are deemed to be free. They are simply diverted to other payers. How much subsidized medical care is enough? That can be debated; but the argument that mandatory insurance is necessary to assure the availability of medical care is fallacious.
Fiscal prudence and viability can be disproved by the evidence. The Class Act did prove financially unsustainable. New regulations are an impediment to full time employment. Insurance companies are fleeing non-competitive markets. (You can mandate guaranteed issue. You cannot require that people sell in non-competitive markets.) Premiums are not falling. In some cases, the premium increases are spiraling. Worse, purchase of the product is now required. Time after time, the opponents of the ACA have been proved right.
Is Obamacare compassionate? Subsidized medical care is charity and charity is compassionate. But Obamacare requires young people to purchase products that they may not need or want at highly inflated prices and to do so in perpetuity. This is the nature of government-funded compassion.
The Republican argument should be this: Health security, compassion and fiscally responsible government interventions are desirable outcomes but the ACA will achieve none of the above. It simply doesn’t work. However, if you were to survey the public about the motives for Republican opposition to further implementation of the ACA, you would more likely hear a) the conservatives are just trying to undermine President Obama again b) Republicans favor business at the expense of the worker c) Republicans are in the pocket of the insurance companies.
I don’t have any special insight into strategy. But three things are clear to me: 1) the window for substantially altering or repealing the ACA is short. It expires in January. 2) Republicans cannot succeed without changing the public perception that their opposition is political rather than principled. However well-intentioned, the ACA doesn’t work. This is an argument that cannot be made half-heartedly or inarticulately. 3) We must have a clear direction in mind.
Republicans should propose treating all currently allowable medical deductions as adjustments to income, making all medical and insurance purchases payable with pre-tax income. It will preserve the right of every person to determine their own insurance needs while bending the cost curve down immediately for every taxpayer. Nothing in the current bill will do that.
Some Republicans want to wait for a perfect storm. We can only choose from options actually available to us. Fashion a competitive alternative, unite behind it and fight for it now. Please call your representative. A perfect storm is not in the forecast.