Congress achieves bi­par­ti­san fail­ure on health care

The Denver Post - - PERSPECTIVE - By Megan Mcardle

For months, I’ve been watch­ing in a sort of won­der as Repub­li­cans crafted the most un­pop­u­lar ma­jor bill in liv­ing mem­ory. Could they re­ally mean to make a sui­cide charge at this — not some long­stand­ing Repub­li­can goal, like dis­man­tling the wel­fare state or slash­ing through the reg­u­la­tory thicket, but push­ing a sly par­ody of Oba­macare even less lik­able than its awk­ward source ma­te­rial?

When Repub­li­cans ex­plained how this would ac­tu­ally be a strong cam­paign strat­egy for 2018, I had as­ton­ished flash­backs to Democrats say­ing the same thing in 2010 — and won­dered when it was that peo­ple in Wash­ing­ton started be­liev­ing their own press releases. Were we re­ally due for the Repub­li­can ver­sion of the 2010 Demo­cratic lem­ming run?

No, ap­par­ently not. Sen. Mike Lee of Utah has al­ways been the man to watch on this bill, the bell­wether who was ul­ti­mately go­ing to lead the Se­nate one way or the other. On Tues­day, he an­nounced that he would vote “no” on the Mo­tion to Pro­ceed, which, trans­lated from the orig­i­nal Par­lia­men­tar­ian, means that this bill is not go­ing any­where. Re­qui­escat in Pace.

On both a po­lit­i­cal and a pol­icy level, this choice is sen­si­ble, even though it leaves Repub­li­cans in a tough place. The ex­changes in many states have been trou­bled for years, and those trou­bles will now deepen as in­sur­ers won­der what the heck Oba­macare is go­ing to look like in a year or two. The only sav­ing grace for Repub­li­cans is that if and when those ex­changes fall into a deep de­cline, they will still be able to as­sign some of the blame to Democrats for their orig­i­nal sin in pass­ing Oba­macare.

For those fac­ing elec­tion in 2018, that is good news, I sup­pose. The bad news is that those ex­changes are still in trou­ble, and Repub­li­cans are go­ing to take a hefty share of the blame if some­thing isn’t done about them. And Repub­li­cans are no closer to a con­sen­sus on what to do than they were six months ago.

This should also give pause to Democrats who want to cheer “Oba­macare is saved!” Oba­macare is now in worse shape than ever. And Oba­macare was not ex­actly in good shape be­fore. Oba­macare was, in fact, wheez­ing and sweat­soaked ev­ery time it had to walk from the couch to the fridge.

Time has not been kind to its in­di­vid­ual mar­ket pro­vi­sions, and now even more reg­u­la­tory un­cer­tainty sur­rounds the pro­gram. While Repub­li­cans de­serve some of the blame for this state of af­fairs, Democrats can­not evade a much fuller mea­sure of re­spon­si­bil­ity, be­cause most of the pro­gram’s prob­lems are con­gen­i­tal, not life­style-in­duced.

Con­sider what would have hap­pened if Democrats had fol­lowed the Repub­li­can Party’s ster­ling ex­am­ple of po­lit­i­cal ex­pe­di­ence: They would have scaled back to a more mod­est am­bi­tion, prob­a­bly a Med­i­caid ex­pan­sion, while keep­ing their hands off the in­di­vid­ual mar­ket. Since most of Oba­macare’s cov­er­age gains came from the Med­i­caid ex­pan­sion, they could have got­ten a sub­stan­tial por­tion of the cov­er­age gains that the law achieved.

More to the point, they wouldn’t have needed to touch most peo­ple’s in­sur­ance at all. Most peo­ple like their in­sur­ance. Mess­ing with peo­ple’s in­sur­ance was what fed the en­su­ing po­lit­i­cal firestorm. That ul­ti­mately ended up torch­ing a num­ber of ca- reers, and the Demo­cratic ma­jori­ties, leav­ing the party un­able to re­pair a jury-rigged bill that had never been strong enough to sur­vive with­out sub­stan­tial po­lit­i­cal sup­port.

Le­gal chal­lenges to a more mod­est bill prob­a­bly would never have reached the Supreme Court level. So states would not have had the op­tion of de­clin­ing the Med­i­caid ex­pan­sion, an op­tion given to them by a Supreme Court look­ing for a com­pro­mise on the con­tro­ver­sial NFIB vs. Se­be­lius case, one that would loosen the law’s stric­tures with­out strik­ing down decades worth of Com­merce Clause jurispru­dence. So all 50 states would prob­a­bly have ex­panded their Med­i­caid pro­grams, thereby not only pro­vid­ing more cov­er­age, but also mak­ing even Repub­li­can sen­a­tors re­luc­tant to touch a pro­gram that was pro­vid­ing their states with a lot of money.

In­stead Democrats fix­ated on “fix­ing” the in­di­vid­ual mar­ket, and passed a draft bill never meant for prime time. In do­ing so, they broke both that mar­ket, and their own party’s ma­jor­ity. The sur­vival of their jury-rigged “tem­po­rary” so­lu­tion in the face of the Bet­ter Care Rec­on­cil­i­a­tion Act is not much rea­son to cheer; the pro­gram is still on life sup­port, and there is no doc­tor in the house. Or in the Se­nate, ei­ther.

Both par­ties are there­fore deeply re­spon­si­ble for the mess we are now in. At this mo­ment, how­ever, nei­ther party looks likely to take re­spon­si­bil­ity for its own fail­ures, much less for fix­ing the prob­lem. Which leaves the rest of us won­der­ing what the heck is go­ing to hap­pen to the health care mar­ket.

The late econ­o­mist Her­bert Stein once ob­served that “If some­thing can­not go on for­ever, it will stop.” That is as true of Oba­macare as ev­ery­thing else. Even­tu­ally, if Oba­macare’s prob­lems get bad enough, some­thing will have to be done, and some­thing will be, as fright­ened politi­cians sur­vey the smok­ing rub­ble of the in­di­vid­ual mar­ket and the flee­ing vot­ers headed straight for the bal­lot box.

But as Rudi Dorn­busch, an­other late econ­o­mist, ob­served, “In eco­nom­ics, things take longer to hap­pen than you think they will, and then they hap­pen faster than you thought they could.” That they stop even­tu­ally, we know. But not where they will even­tu­ally come to rest, or who they might run over en route.

Email Megan Mcardle at mm­car­dle3@ Fol­low her on Twit­ter: @asym­metricinfo

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