Here’s my problem: I’m a Bill of Rights guy in what’s become a Second Bill of Rights country. That’s why I can’t work up much of a pulse over the intramural healthcare debate among Senate Republicans.
The Democrats, the party of Obamacare and the dream of socialized medicine, has for Trump-deranged reasons become the Party of No on the matter of addressing the catastrophe they have wrought. So, the Senate debate, like the GOP-controlled House debate before it, is a family fight. The family is splitting up, though. The dynamic that led to Donald Trump’s election tells us why. The party no longer stands for what it has long purported to stand for: freedom, self-determination, and limited government. Nothing better illustrates this than its Janus-faced approach to Obamacare.
Republicans, of course, have campaigned full-throatedly on the imperative to “repeal and replace” Obamacare for seven years. They’ve never been serious about it for a moment.
To be trendily trite, I’m old enough to remember when “repeal and replace” was deceptive because it understated the party establishment’s commitment to the GOP’s conservative base. In the beginning, Republicans boldly beat their chests and bellowed that they’d repeal Obamacare root-and-branch. “Repeal and replace” was actually the first moving of the goalpost, the first implicit admission that, in principle, they were all for a government-managed health-insurance system. If you really want to move to the free market, you repeal statism. When you’re talking “and replace,” you’re just haggling over the price.
In a few short years, “repeal and replace” has gone from a subtle understatement of what Republicans conned voters into believing they’d do, to a gross overstatement of what they’re willing to try. No one who has been paying attention can be surprised by this regression.
Obamacare has always been sleight-of-hand, on both sides. From the beginning, Democrats lied about its feasibility: “Like your doctor, keep your doctor,” “like your plan, keep your plan,” plunging premiums, lower costs, etc. All the while, they knew it was unworkable. That was not a flaw, it was the design. The plan was to orchestrate a collapse of the private insurance market, blame the private insurers rather than the death-spiral regulations, and gradually inure people to the need for a complete government takeover—the panacea of “single payer.”
Equally patent is that, at most, Republicans wanted to slow the train down, not stop it. Many of them, after all, have been on it from the get-go. “Repeal!” and, then, “repeal and replace” made for great fundraising and electoral wedge issues. But when it got down to brass tacks, it was always “Maybe the Supreme Court will strike it down,” or “Maybe we can sue Obama over these waivers,” or “Maybe it will collapse of its own weight.”
Republicans have controlled the House, where all spending originates, since 2010, and the Senate since 2014. Not a dime for Obamacare could have been spent had they not approved it. Never did they use the power of the purse as the Framers intended: Congress’s decisive check against ruinous policy.
That is because today’s Republicans do not see government as the Framers did—as a necessary evil that must be limited, its powers diffused so its tyrannical tendencies can be suppressed.
The modern GOP is the party of the Bushes, John McCain and Mitt Romney (the architect of Romneycare, Obamacare’s progenitor). These are fine, patriotic Americans, but limited government conservatives they are not.
“We have a responsibility,” President Bush proclaimed in 2003, “that when somebody hurts, government has got to move.” Government, in the modern GOP telling, is a force for good, not a necessary evil. You start thinking like that, it’s a short leap to convincing yourself that government can get everybody covered—not that the “coverage” would be a mirage and that statism would undermine the system of medical care.
Four years ago, the conservative crusade to defund Obamacare collapsed due to lack of GOP support—actually, due to surfeit of GOP derision. As unrealistic as the Republican establishment portrayed Senator Ted Cruz’s defunding strategy to be, at least it was a strategy— akin to a Hail Mary pass. The desperate aim was to kill Obamacare in the cradle, before its tentacles spread, making its reversal politically untenable.
By contrast, as I contended at the time, the GOP had no strategy to undo Obamacare because it had no intention of undoing Obamacare. To repeat just some of the reasons I outlined back then:
Remember, Republicans are the guys who gave us a new Medicare prescription-drug entitlement when Medicare was already tens of trillions of dollars in debt. They are the guys who ran in 2012 as the saviors of Medicare—even though they well knew that slamming Obama over taking money out of Medicare would make it much more difficult to address Medicare’s unsustainable costs in the future. They are the guys who accept core premises of Obamacare: Republicans do not make the case that health care is like any other commodity in a free market rather than a corporate asset to be centrally managed. The disagreement between statist Democrats and the GOP establishment is about the degree of government intrusion in health care, not the matter of government intrusion in principle. Republicans are also the guys who want to keep some of Obamacare’s core, anti-free-market elements—e.g., provisions that forbid denial of coverage owing to preexisting conditions and that keep “children” on their parents’ coverage until age 26.
The Democrats, the media, and all the Left will tirelessly portray any proposed repeal of Obamacare as a callous denial—a removal—of coverage from millions of underprivileged Americans, including those struggling with sickness. Moderates and “compassionate conservatives” already lecture us about the need to get real and make our peace with the welfare state; what will they be saying four or six or eight or who knows how many years from now? They will be arguing that Obamacare’s prodigious infrastructure is now part of our social fabric—that repealing it at this point (whenever that point happens) would be radical, the very antithesis of the Burkean conservative disposition. The GOP’s will to fight for repeal—which has never been as strong on action as it is on election-season rhetoric—will dissipate.
Well, here we are.
It was inevitable. After all, how many Republicans today would enthusiastically endorse Franklin Delano Roosevelt’s “Second Bill of Rights”? In Washington, nearly all of them, I’d wager.
As an up-and-coming “progressive” state senator, Barack Obama berated the Constitution as a “charter of negative liberties.” He was referring to the Bill of Rights, which says what government may not do to you—suppress your speech, deny your freedom of conscience, subject you to unreasonable search and seizure, take your life, liberty or property without due process of law, and so on.
Progressives, to the contrary, champion the Second Bill of Rights posited in FDR’s 1944 state of the union message. It is the wish-list of things government must do for you. It departs radically from liberty’s premise that the sovereign states and people do best when they do for themselves, with minimal interference from Washington. And it conveniently elides mention of the stubborn fact that government—which is a structure, not a guardian angel—lacks the means to do anything for anyone: It can only do for me if it takes from you.
Prominently included in the Second Bill of Rights is “The right to adequate medical care and the opportunity to achieve and enjoy good health.” It sounds wonderful—who would want to deny anyone the ability to seek health care? But even where rights were codified, they had never been understood to include the right to have other people pay for our enjoyment of them.
This is why the Second Bill of Rights has never been adopted, at least formally. It is, similarly, why the United States has never ratified the International Covenant on Economic, Social and Cultural Rights, which purports to guarantee “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” by government’s “creation of conditions which would assure to all medical service and medical attention in the event of sickness.”
How many of today’s Republicans do you figure would dare publicly oppose the proposition that there is a right to medical care? If you’re using your hands to count and still have fingers to spare, it is a measure of how unserious we have become about actual healthcare.
Just as our fact-free, narrative-obsessed society has contorted the idea of a “right” into a subsidy, so too have we twisted opposition to federal control of a good or service into a desire to deny that good or service to others – naturally, because we are racist, sexist, ageist, and in the “intersectional” thrall of a -phobia catalogue.
It is simply a fact that centralized Washington control over health coverage, and thus of healthcare, is a disaster. It is unaffordable. It inevitably produces lousy medical outcomes. It drives costs ever higher. It incents the young and healthy to go without insurance, thus making coverage prohibitively expensive for the older and sicker. It stifles experimentation and innovation. It is unsustainable. And it is beyond tinkering here and a band-aid there because the cancer killing the patient is the government’s managerial role.
We do not have a major political party in this country that believes this enough both to say it and to act on it. We do not have a party willing to say that, in our system, health insurance and medical care are supposed to be left to market forces and regulation left to the states—which are best able to address the needs of their citizens. We do not have a party willing to insist that the way to achieve affordable, quality coverage while providing help to people who truly need it is best charted by 50 states free to compete, experiment and imitate; it will never come from Washington.
We need such a party. For now, we have Obamacare Democrats and Obama-lite Republicans—the express and the local, headed for the same train wreck.
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