Mitch McConnell is once again announcing that the Senate is going to come out with a new health care bill and try to hold a vote next week. That exhaustion you feel is the same despair that seeps over you when a pair of ill-matched friends announce for the 17th time that they’re getting back together.
As with those friends (we all have them, don’t we?) there seems to be no set of mutual goals upon which a durable partnership can be built. Many Republican legislators want Obamacare to die. Others would probably attend the funeral with ill-concealed delight, but they don’t want a reputation for having killed it. Still others would like to be able to tell voters that they “did something” about Obamacare, even though in reality they are loath to actually, you know, do something — because their states would lose money, or voters would lose insurance.
Indeed, these may not be discrete factions of Republicans on the Hill. Often these desires seem to war within the same head. Small wonder that the party works on the compromise bill, the more it inches toward the status quo. As Phil Klein of the Examiner noted this week, “Brick by brick, GOP versions keep restoring parts of Obamacare.”
Whether or not you think the status quo preferable, that’s going to be a tough sell to a lot of senators — and even if they pass it, in the House it’s going to be … challenging. The hard-liners in the lower chamber aren’t going to rubber-stamp a bill that looks like Obamacare with the fonts changed.
In the old days, of course, the solution to those conservative defections would have been to pick up some moderate Democrats and pass a bipartisan bill. But that seems a long time ago, and political galaxies away from where we are now. Or is it? Republican Senator Lindsay Graham of South Carolina says he’s crafting an alternative, bipartisan bill that might offer a way out of the Obamacare mess, a more viable path than either the AHCA or the BCRA.
Cue the movie clip of a guy saying “It’s so crazy, it just might work!” Then turn to the question that naturally follows: What should a bipartisan health care bill look like? We vaguely recall how bipartisanship worked, back when it worked. Compromise. Horse-trading. Quid pro quo. What should Republicans be willing to give up to get enough Democrats on board?
As an exercise on paper, the answer is easy:
Stop trying to make this a tax-cut bill, and focus on reforms that can pave the way to fiscal stability, and dismantling many of the perverse incentives that have so distorted our health care system. Leave Obamacare’s taxes intact. (Yes, even the dumb ones, of which there are many.) Leave the individual mandate unless you can muster the votes to take out community rating and guaranteed issue. Turn Medicaid into a fixed grant rather than an open-ended entitlement, either by making it a block grant, or switching to a flat per-beneficiary payout — but don’t try to make block grants a confusing cover for very deep cuts to the program. Provide generous funding to stabilize the individual health-insurance exchanges, but demand in return very wide latitude for states to decide how they stabilize their insurance markets — including jettisoning any of the Obamacare regulations they think are getting in the way. Meanwhile, move the system more aggressively toward health-savings accounts plus catastrophic insurance—and get Democrats on board by offering to have the government fund some portion of those health savings accounts for low-income citizens.