The Obamacare IED

Republicans won't be able to please everyone. So what will they choose?

Bruce Thornton is a Shillman Journalism Fellow at the David Horowitz Freedom Center

The Republicans have started fixing the Obamacare disaster. For Trump, doing something about this failed program is critical, since it was a central issue he campaigned on. As his consigliere Kellyanne Conway says, there is a “binary choice … you’re either making good on the promise to repeal and replace Obamacare or you’re not.” Failing to deliver on this promise will have serious repercussions for the 2018 midterm elections and Trump’s own reelection

But right now, the Congressional bomb-squad trying to defuse this political IED are squabbling among themselves. Some claim that the changes proposed so far are a good start, for a complex and flawed entitlement like Obamacare will take time to fix. Others say what Paul Ryan et al. have proposed is merely “Obamacare lite,” Republican lipstick on that budget-busting entitlement pig. Dems on the sidelines are piling on, desperate to preserve Obama’s “legacy,” which also happens to be a big step toward the Holy Grail of progressives–– government-run, single-payer health care on the European model.

But the real problem continues to be ignored––the success of the progressive movement in addicting Americans to getting something for nothing because that “something” is defined as a “right.” And voters don’t like their rights messed with.

That’s the political conundrum facing the Republicans. Those in the Paul Ryan camp defend their adjustments to Obamacare by pointing out the greater participation of the market in their reforms. Here’s Ryan making the case:

It’s something that we as conservatives have always said if you really want to get free market principles injected into the health care system, you need to have an individual market where people care about what things cost, where people have real freedom, where those providers of health care services, be they insurers, doctors, or hospitals and everybody in between, compete against each other for our business based on value, based on price, based on quality, based on outcome. You don’t get that if you don’t have a viable individual free market.

All true, except the one thing Ryan doesn’t mention, and that’s the individual’s responsibility for his free choice. Whenever we talk about freedom of choice in the free market, we have to be clear that making the wrong choice, or a bad choice, will have consequences. Freedom without responsibility and accountability for how we use our freedom is a recipe for disaster. We all know, for example, that a lot of health-care money is spent on ailments related to lifestyle choices. About 28 million Americans have type-two diabetes. Obesity, poor diet, and lack of exercise are mostly responsible for this rising epidemic. In 2013 we spent $250 billion treating this disease, including the cost of lost productivity. The government paid 62 percent of this tab, and one in three Medicaid dollars was spent on diabetes. These costs will increase significantly as an aging, longer-living population becomes more vulnerable to the disease. And everyone expects the government to foot the bill.

But don’t even dare mention personal responsibility when talking about exploding health-care costs covered by the government through the redistribution of other people’s money.  That would be “blaming the victim,” a demonstration of callous inhumanity even when the victim is responsible for his plight. This attitude partly reflects our therapeutic sentimentalism about suffering, a luxury rich societies think they can afford. But it also is a consequence of a bad idea that progressives successfully institutionalized in our politics.

This is the rejection of the founders’ idea that rights, whether they come from nature or nature’s God, belong to us by virtue of being human, and are beyond the power of the state. Now “rights” are any good thing we happen to want. Progressive theorist Mary Parker Follett wrote in 1918 that rights do not exist apart from society, and that we, by which she means the state, should create “social rights” and “all the rights we shall ever have.” Franklin Delano Roosevelt expanded this notion in a 1932 campaign speech when he spoke of the “redefinition of these rights [in the preamble of the Declaration of Independence] in terms of a changing and growing social order.” So he expanded the “right to life” to include, for example, the right “to make a living––a living decent according to the standards of the time.” 

FDR’s 1944 State of the Union address expanded this new notion of rights even further, for the rights protected in the Constitution “proved inadequate to assure us equality in the pursuit of happiness.” Thus he called for a “second Bill of Rights.” But what the founders defined as the defining bases of human nature that preexist government, FDR defined as good things and benefits people may want, but that depend in the main on their own talent, efforts and virtues. Now a “useful and remunerative job,” “adequate food and clothing and recreation,” and “adequate medical care and the opportunity to achieve and enjoy good health,” and many other good things are rights. And these “rights” should be protected and advanced by the government, which pays for them by redistributing wealth.

Seven decades later we see the consequences of this radical redefinition of rights. Most important is the multiplication of such rights, and the escalating standards defining them, that will necessarily follow such elastic and subjective words like “decent” or “adequate.” Today, “adequate health care” includes frequent visits to the doctor for transient ailments like colds or a sore back, a new knee or hip when we get old, copious pain-killing and mood-altering drugs, drug and alcohol rehab, and gastric bypass surgery. That insidious expansion of what “adequate” comprises accounts for most of the massive debt, deficits, and unfunded liabilities incurred by meeting these ever-rising and costly expectations among the citizenry. When it comes to health care, what the voters want, as the Washington Post’s Charles Lane put it, is “a plan with abundant covered services and choice,” one that “shift[s] as much of the cost as possible onto someone else, while protecting the poor, but for heaven’s sake don’t make it ‘government-run.’” 

This the political time-bomb the Republicans are trying to defuse. If health care is a “right,” then how can they take it away from people who are now getting it through subsidies or Obamacare’s expansion of Medicaid, both paid for by the taxpayers? How can they get rid of Obamacare’s popular provisions, like the one that health insurers cannot exclude those with preexisting conditions? Why do the rich and those with private plans get to enjoy the right to health care, and the rest don’t? The political price, however, for ending one of the most expensive benefits of Obamacare like guaranteed acceptance despite preexisting conditions is likely to be punitive for any politician proposing its elimination. But keeping it and figuring out how to pay for it is a huge problem, one that the “free market” or technocratic tinkering isn’t going to solve on its own.

In the end, the current GOP plan will still be run by the government and paid for by the government with taxpayers’ money. The voters won’t settle for anything less. But a complete repeal could cause an electoral disaster. So which wire does the Republican bomb-squad cut?