I don’t profess to know all of the intricacies of Healthcare. I have no idea how block grants, risk pools, Medicare, Medicaid, the VA, Tort reform, and Exchanges all combine into a functioning healthcare system. I would argue very few people actually can accurately predict the outcome of such a complicated set of moving parts.
Essentially, healthcare comes down to one argument: Do you want government handling healthcare or not?
On one side we have Conservatives and Libertarians, who want essentially no government involvement, and for the system to be entirely free market. To a large extent, they have already lost, as we have Medicare, Medicaid, and the VA, all of which are state run. Several conservatives in Congress are basically liberals, and are for varying degrees of government control. We see the Conservative divide right now, as the Senate could not get the requisite number of votes to pass the repeal and replacement of Obamacare.
On the other side, we have the Socialists and Progressives, who want single payer. In other words, they want a system that is entirely government run. Several countries run this model, and it’s hard to get a truly unbiased look at how it runs. For every person you hear talk about how great it is, there is another that waited 40 weeks for treatment, or had to come to America to get their care. The Charlie Gard case clearly illustrates the issues prevalent in government run healthcare.
This situation is largely a losing proposition for Republicans. If they manage repeal, with replacement or not, then Democrats have their 2018 campaign written for them: The Republicans voted to take healthcare from millions of people, and pushed Grandma off the cliff. On the other hand, if they fail, then Democrats can easily say that Republicans can't govern, as they couldn't get it done with a Republican House, Senate, and Presidency. The final option, is to do nothing and “Let it Implode” in which case you end with the same result as failing. In other words, even though the current situation is their fault, Democrats hold the winning hand on Healthcare. In addition, with the complicity of the mainstream media, it is the Democrat messaging that will be parroted night after night.
I don’t consider myself a conspiracy theorist. However, I do believe there is substantial evidence that Obamacare was designed to fail, and to be almost impossible to repeal. Everyone knows it’s virtually impossible to remove an entitlement, to say nothing of the 60 vote threshold to fully repeal it. This is legislation that is quite literally thousands of pages, and is interwoven amongst every aspect of healthcare. President Obama has said multiple times he is for single payer. It’s entirely possible that they knew it couldn't work long term, and since they thought they'd be in power, they could then slide right into single payer. The dream for Democrats is to have every citizen reliant on the government, thus ensuring that they maintain their power, a concept which they cloak under the guise of goodwill.
I will postulate another theory. I believe it’s possible President Trump wanted this bill to fail. Donald Trump is a strategic, non linear thinker. I believe it’s possible he knew the lose-lose scenario I talked about above would be a problem. Everyone hated the bill, Left and Right both savaged it regularly. When Donald Trump really likes something, or wants something badly, he hard sells it. I didn’t see him out giving speeches about how great this bill was. He certainly didn't label it TrumpCare, which he would in a heartbeat if he believed it was a great bill that had wide support. This is a man that literally puts his name on everything, and he wanted no part of this bill because he knew it wasn’t a winner. I believe there are two possibilities: One, this was a tactic on his part to force bipartisanship. Republicans have to come to the table because they couldn’t pass their own, and Democrats have to because Obamacare is failing. Two, is that he wanted it to fail so he could see who needed to be primaried in 2018. Maybe he does want the full repeal, and needed to see who would go on the record opposing a full repeal, like Susan Collins. What I do know about President Trump is that he won’t back anything with his full weight that he doesn't believe has mass support. A lose-lose proposition is not something he will back.
So where do we go from here? Personally, I’d like to see Leader McConnell go for the nuclear 50 vote full repeal. I want highly customized, completely free market solutions. However, the Majority Leader has said on multiple occasions he would never do that for legislation. I can't blame him, because if Democrats ever get into power, they would be more than happy to abuse that change, as Republicans did to confirm Justice Gorsuch. That makes this an extremely unlikely solution, to say nothing of the fact that some liberal Republicans like Susan Collins, would likely vote against this option.
With all that said, I believe the Senate should have passed the Better Health Care Act, then engaged the private sector to come up with more innovative solutions, in the realm of Artificial Intelligence and digital solutions, selling across state lines, and virtualized health care. I don’t believe any conservative can say that the BHCA wasn’t an upgrade from Obamacare. It may not have been as free market as they wanted, but now we have nothing, and a full repeal is a near impossibility. I really like Rand Paul, and his fervent defense of constitutional conservatism, but he virtually killed the entire legislation by himself. His opposition, and constant media appearances, emboldened others to stand against what was clearly superior to Obamacare.
The real story here is the ineffectiveness of the Republican Senate. So far, the Senate has been largely stalled, with little legislation, and hundreds of Trump appointments still not approved. The archaic Senate rules that the Democrats are using to obstruct, must be addressed. It’s time for the Republicans to stop playing defense constantly, and allowing Democrats and their accomplices in the media to set the narrative. They now have a President who moves at a lightning pace, with limitless energy, so it’s time for Senate Republicans to get to work. No longer will we accept excuses and inaction. Leader McConnell and Senate Republicans need to understand that we are watching, and elections are upcoming. Any Republican that does not stand for the President’s America First agenda is in just as much danger of being primaried as a Democrat.
Let this be a message to every Republican:
Every single Republican campaigned on delivering serious Healthcare reform. The President campaigned on it, and we don’t blame President Trump. If Republican senators are unwilling or unable to act, then we the people will find candidates that will deliver. Maybe that’s exactly what the President wants.
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Steve is the founder and CEO of Americana Prime.