Republicans have been winning elections for years by promising to repeal and replace the Affordable Care Act. Now that the dog has caught the car, we have to know what to do with it. Republicans have captured the White House, and kept the House, Senate and a majority of the governors’ offices. There are no more excuses, and voters are rightfully expecting quick and bold action.
Already, though, the media is beginning to highlight or perhaps even create differences among the Republican victors, with stories about some in the party wanting a quicker timeline for repeal than others. Before we get bogged down by a debate about whether Obamacare should be repealed within two or three years (and I am for sooner than later), it would be helpful to remember why conservatives have opposed Barack Obama’s health law so vehemently. And no, despite the president’s protests, it is not simply because of the name. Articulating our principled objections will help inform how Republicans should replace this flawed legislation.
Obamacare has famously failed to live up to its sponsor’s lofty promises, as evidenced by health-care costs and premiums that continue to rise at an unacceptable rate, as well as millions of Americans losing their preferred health-care plans and access to their physicians. But there are three deeper fundamental failures embedded in the law that must be fully repealed and not transplanted into any Republican replacement.
First, Obamacare involved a massive increase in federal taxes and spending. Our federal government now spends more, and has borrowed more, than ever before. No society has ever taxed, spent, or borrowed its way into prosperity, and we will not be the first. It was wrong to increase government spending, to create a massive new entitlement program, when we could not afford the government we already had. Mortgaging our children’s future to sustain our bloated government could render us the first generation of Americans that leaves behind fewer opportunities than those we inherited from our parents.
Some Republicans want to forfeit this fight before it even starts. They argue it is not realistic to return to pre-Obamacare levels of federal spending and taxation, that any repeal plan that taxes and spends even one dollar less than Obamacare is a victory. Nonsense. If the conservative response to eight years of unprecedented liberal spending is to simply slow the pace, rather than reverse the direction, then we are done. What is the point of winning elections if we are not committed to shrinking government spending and government dependence? Pretending to be cheap liberals has never been a winning strategy; we must instead be honest conservatives. We must repeal all of the new Obamacare spending and taxes, and consider that our baseline against which we measure any repeal plan.
Second, Obamacare made millions of able-bodied Americans newly dependent on direct government assistance for their health care. Whether through a massive expansion of Medicaid beyond its original target populations of poor children, disabled and the elderly, or through exchange subsidies for the vast majority of participants, Obamacare masked the true cost of health care, rather than truly “bending the cost curve down.” Pretending that subsidized health care is affordable without considering the true cost to taxpayers is disingenuous at best.
We must not allow liberals and the mainstream media to define success by the number of Americans dependent on government programs. Republicans should focus instead on market-based solutions that make health care more affordable for all Americans. Targeted, flexible and temporary safety-net solutions, governed at the local level, are preferable to centrally run, top- down, one-size-fits-all subsidies that reduce the incentive to work and make millions of Americans newly dependent on the government. Health-care reform must not continue to be a Trojan Horse for yet another massive liberal redistribution program.
Third, Obamacare inserts the federal government into the health-care system, reducing the autonomy of patients and providers. In addition to the much-derided individual and employer mandates, the federal government is now involved in micromanaging health-care plans. Some of this is the inevitable result of the government regulating what it subsidizes (another argument against general government dependence). Federal lawmakers and bureaucrats now find themselves trapped in an endless cycle of cutting provider prices, imposing volume caps and restricting access to new, expensive or alternative procedures, yet they still fail to meet budget targets.
Insurance companies increasingly resemble regulated utilities, offering only the veneer of private sector choice and competition, while federal bureaucrats dictate product design and pricing. Just as customers were allowed to buy any color Model T they wanted, as long as they wanted black, Americans today are allowed to buy any health insurance product they want, as long as they want what the federal government allows them to have. Providers are increasingly merging to achieve the economies of scale necessary to comply with increasingly complex federal regulations. Innovation and competition are stifled as big businesses and big government become interdependent in yet another example of crony capitalism. The unintended consequences have included skyrocketing premiums, decreased plan choice and limited provider networks.
Conservative health-care reform should be based on three principles: competition, individual autonomy and local governance. There is no reason to suppose Washington is constitutionally empowered, much less competent, to make our health-care decisions for us. Consumer choice should be expanded within Medicare, the states should have more flexibility in designing and running their Medicaid programs and Congress should stop doing the work of state insurance commissioners. But even more importantly, we must trust patients and their doctors to make decisions for themselves.
This moment is a major test for Republicans. Health care consumes a large and growing share of our economy, involves people at their most vulnerable moments and often has life or death consequences. Republicans have a unique opportunity to demonstrate that our principles are better, that trusting the American people over the bureaucrats is a sure bet every time. Repealing and replacing Obamacare consistent with conservative principles will prove that we are serious about draining the swamp—not just winning elections.