By Caroline Baum
Last week, Republicans in the U.S. House of Representatives voted for the 41st time to repeal or dismantle parts of the Patient Protection and Affordable Care Act. And no, the 42nd time is not going to be the charm.
What exactly is the Republican endgame? Initially, it may have been about what House Speaker John Boehner calls the "optics": allowing newly elected members to cast a symbolic vote on the law. Now they just look like spoilers.
Back in May, The New York Times calculated that since Republicans took power in 2011, they have devoted "no less than 15 percent of their time" on the House floor to repealing or modifying the law. Lawmakers might just as well meet biennially if this is how they are going to spend their time.
The healthcare act is the law of the land. It survived a Supreme Court challenge. That should appeal to the libertarian wing of the Republican Party.
Whether you're a fan of Obamacare or think it's the worst thing since socialized medicine (or that it is socialized medicine), you have to wonder what on earth the Republicans are up to. If Obamacare is so unworkable — if the inherent structure is so flawed as to increase demand for healthcare, reduce supply and send costs soaring — why not allow the law to be fully implemented and watch it implode? Wouldn't that better serve their purposes, whatever they may be?
It is popular among conspiracy theorists to claim that Obamacare is a Trojan horse, a surreptitious way to introduce a single-payer system of universal healthcare. If you buy that argument, it follows that you have to kill it before it morphs into something else.
If you aren't partial to tinfoil hats, a better argument would be that time is running out. On Oct. 1, the state health insurance exchanges will open for business. (The insurance purchased doesn't take effect until Jan. 1.) Once the subsidies start flowing in January to low- and middle-income families, the law will be very hard to reverse. As Ronald Reagan put it: "The nearest thing to eternal life we will ever see on this earth is a government program."
The latest Republican gambit is an attempt to link a vote on a continuing resolution to fund the government after Sept. 30 to a rider that defunds Obamacare for a year. President Barack Obama chose to delay selective portions of the law, including the employer mandate, for a year. And Congress has already passed seven bills, which were signed into law, to repeal or delay parts of the healthcare act. Under the circumstances, delaying the funding for a year makes perfect sense.
There is no chance of such a measure winning Senate approval. If it did, Obama would veto it. He's already started to blame the Republicans for shutting down the government — two weeks hence.
Republicans do have a plan, even though you may not have heard about it. Rep. Tom Price, R-Ga., has introduced H.R. 2300, the Empowering Patients First Act, just as he did in the 111th and 112th Congresses. Price, a physician, says the goal of his patient-centric proposal is to ensure access to health coverage for all Americans, control costs, solve the problems of portability and pre-existing conditions and improve the healthcare delivery structure.
Under Price's plan, Americans would own their coverage, taking it with them when they change jobs. It would level the playing field by offering individuals a tax deduction, in addition to a refundable tax credit, for purchasing insurance. It would save billions of dollars by addressing lawsuit abuse, freeing doctors from practicing defensive medicine. And yes, it would repeal Obamacare. The American public needs to hear more about the alternatives, about "replace" rather than "repeal."
In addition, Republicans could emphasize the two biggest problems with today's healthcare system: the fee-for-service cost structure, which encourages unnecessary procedures, and the system of employer-based coverage, a holdover from World War II. Faced with chronic labor shortages and a freeze on wages, employers started to offer health insurance benefits as a way to attract and retain employees. That the healthcare law — the biggest piece of social legislation since Medicare in 1965 — failed to address these issues and tackle rising costs makes you wonder what all the time and effort was about.
I know — it was about providing healthcare to the 30 million uninsured Americans. In the United States, they end up getting care in the emergency room, which is the least cost-effective option. So unless all the talk about an aging population and spiraling healthcare costs is a fiction, there is every motivation for Republicans to come up with a solution.
When Republicans took control of the House in 2011, the largest caucus by far was the Republican Study Committee, a conservative group committed to ideological purity. Nothing there about governing. Members seemed to delight in being called the "Party of No."
With less than two weeks to go before the insurance exchanges kick in and the federal government's spending authority runs out, the study committee has just unveiled its own alternative to Obamacare. It's a bit late, but maybe the "Party of No" is starting to focus on "Getting to Yes"?
Caroline Baum, author of "Just What I Said," is a Bloomberg View columnist.
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