The Unaffordable, Uncaring Act

It’s not just that the Republican Congress and the Republican president failed to repeal and replace the Affordable Care Act. They lost out in the messaging derby. They failed to present their ideas. They failed to show how badly the ACA was failing. They did not communicate effectively.

Fair enough, it is not easy to present an argument against the ACA when the television news is filled with pictures of distraught citizens explaining that if you repeal the ACA they are going to lose their health care and die. And it is not easy to communicate when senior Republican officials from around the nation are standing before the cameras, trashing every alternative.

At the least, it signals a Party in disarray. Some would say that it shows an absence of leadership.

Fair enough, Donald Trump did not know enough about the issue to provide any presidential leadership. And yet, shouldn’t Tom Price have stepped up? I suspect that this is one of the reasons why Price is now a former cabinet secretary.

Where the Great Communicator was when we needed him? He was nowhere to be found. It was fairly obvious that a petty and vindictive John McCain let personal grievance get the better of his so-called judgment. Obviously, McCain gets great press for being disloyal to his party. Shouldn't he know better than to be suckered by it?

Kimberley Strassel described McCain’s reasoning:

The Arizonan has never gotten over losing the presidency, and it clearly irks him that Mr. Trump succeeded where he failed. His personal disdain for the president is obvious, and his implausible excuses for opposing the Graham-Cassidy health-care reform are proof that this is personal.

As for Rand Paul, Strassel explains him well:

Sen. Paul’s standards for “conservative” policy are as varying as the wind, and lately they blow toward whatever position can earn him the title of purest man in Washington.

Democrats seem to understand party loyalty. When push comes to shove and the votes are needed, they round them up. Republicans often pride themselves on being mavericks, on having a conscience that tells them to vote against their party interest. 

Then again, the current Republican president is not exactly a party loyalist. His supporters thrill to his unconventional style. They are less thrilled to see that when you insult your way to the presidency, your opponents do not feel any special loyalty to you.

To be fair and balanced, Congressional Republicans have been promising to repeal and replace Obamacare for seven years now. That they did not have a plan, a proposal, a piece of legislation ready to go… is frankly inexcusable.

Such thoughts come to mind when reading Kevin Williamson on the ACA. An excellent essayist, Williamson laid out the case against the ACA. Since members of Congress and the administration did not seem capable of making the case against the ACA, someone had to do it. He set the foundation for an effective communication strategy.

  

The Affordable Care Act has not worked as advertised. That is the fundamental fact around which the debate should be organized. The ACA did not result in lower premiums but in the opposite; it did not result in more competitive insurance markets but in the opposite; it did not result in superior health-insurance plans but, at least in many cases, the opposite; it has not resulted in universal coverage. Among the major promises made on behalf of the ACA, only one of any significance has been delivered on: It is the case that more Americans have health insurance today than they did in 2009. But the ACA has underdelivered on that point, too: Only about 16.5 million people — barely 5 percent of the population — gained health coverage from the passage of the ACA through 2016, and the vast majority of those, 81 percent, were new Medicaid beneficiaries.

If we were thinking rationally, we would begin with the fact that the ACA has failed. Unfortunately, we are no longer allowed to think rationally. We are not allowed to say that the ACA failed. We are especially not allowed to say that Barack Obama failed. And we are certainly not allowed to say that he lied to the nation, over and over again.

The great American conversation about race has been filled with lies about the relative success of President Obama. If you speak ill of BHO, you are a bigot and will be tossed into the sixth circle of the Inferno. As for the possibility that BHO will admit to anything resembling failure… good luck with that. It will not happen. It is one of the reasons why the nation’s psyche is falling apart. It is one of the reasons why people can barely engage in a civil discussion any more.

So, Williamson points out that if we were pragmatists and if we accepted the verdict of the marketplace, we would understand what any good businessman understands. When a product fails in the market, you remove it from the market. Or you improve it significantly.

Under the aegis of our last president we have become a nation of fanatics, more concerned with belonging to the right tribe, less concerned with what does and does not work. Our thinking has lost the quality of reason.

Williamson explains:

Because our political identities are shaped by tribalism rather than by reason, creating a political culture that embraces healthy experimentation and iterative, incremental reform is difficult for us to do. What we do instead is put together unwieldy bundles of legislation that promise to solve a particular problem for now and for all time — and then accuse the other side of being evil for opposing it. That isn’t government — it’s performance art.

Democrats are happily preparing to blame Obamacare’s failures on the Republicans. Since we are dealing with care and compassion, they are in their bailiwick. They play the sentimentality card for all it’s worth:

The defects of the ACA are plain for all to see. Everybody knows what they are. But what has been the Democratic response to attempts to fix them? Screeching that Republicans are cruel, that they hate poor people, or that they are influenced by obscure financial motives. What those financial motives might be is not obvious: The biggest financial players in the health-insurance industry, the insurance companies themselves, generally supported ACA and generally opposed recent Republican reform efforts, especially the repeal of the mandate that obliges every American to buy the products the insurance companies sell. And the insurance companies like the Democrats’ current big idea on health-insurance reform: burying the insurance companies in bailout money to cover up the problems created by the ACA.

Williamson seems to have accepted that Republicans cannot do it on their own:

The Affordable Care Act is the New Coke of Democratic domestic-policy initiatives, the McAfrika sandwich (“based on an authentic African recipe”), the Clairol Touch of Yogurt Shampoo. You know what all those products have in common? They’re gone. But the Coca-Cola Company, McDonald’s, and Procter & Gamble still exist. They’re doing okay. They understood their failures, fixed them, and moved on to better and more profitable things. Eventually, we’re going to have to do the same thing when it comes to health insurance, and the sooner the Democrats get on board the less it is going to hurt.

In truth, we might not ever try to fix it. We might try to paper over its failures by throwing more money at it. Isn’t that the Washington way of doing things.