Skip to comments.Are ‘Repeal and Replace’ and ‘Reform’ for Obamacare Interchangeable?
Posted on 05/02/2014 2:56:17 PM PDT by SeekAndFind
Ramesh is kind enough to cite a recent piece of mine for Forbes, describing it as a continuation of my lonely campaign to get conservatives to drop the idea of repealing and replacing Obamacare and instead to embrace reforming it. But its only lonely if by lonely he means shared by a large plurality of the electorate.
Let me cite the data. A Pew Research poll asked whether or not politicians should make the law work as well as possible, or make it fail. The work side won 3019 overall, and 3619 among independents. (Make it fail won among Republicans, but only by three points: 4340.)
Now, the Pew poll used skewed language. So lets look at some other surveys. A poll from the Kaiser Family Foundation offered four options: keep the law as is, keep the law in place and work to improve it, repeal the law and replace it with a Republican-proposed alternative, and repeal the law and not replace it. 49 percent of respondents chose work to improve, with only 29 percent choosing repeal (18 percent) or repeal-and-replace (11 percent). Independents reflected the overall numbers, with 44 percent choosing work to improve, with 32 percent supporting repeal (23 percent repeal and 9 percent repeal-and-replace).
Not convinced? A Bloomberg News poll found 51 percent supporting it may need modifications but we should see how it works versus 34 percent supporting repeal. NPR tallied 53 percent for implement and fix and 44 percent for repeal.
You get the idea. Now this is not to say that public sentiment is in any way a substitute for good policy. But it is to remind conservatives that any agenda we wish to enact will require public support, in the form of electoral victories, in order to succeed. Remember also that any replace plan will require the consent of 60 members of the United States Senate (as would any other type of reform).
Rameshs principal concern appears to be that if we move away from the slogan of repeal and replace, well fail to galvanize opponents of the law in upcoming elections. But while his main concern appears to be 2014, mine is 2016, during which those who benefit from the law will be equally galvanized by the fear that their coverage will be taken away.
As he notes, the end result of a reform-based approach is not entirely dissimilar from that of the best repeal-and-replace plans, such as the one from Senators Coburn, Burr, and Hatch. But if you can achieve the same result, with less disruption of peoples existing insurance arrangements, why wouldnt you choose the less disruptive path?
On that score, Ramesh argues that migrating the Medicaid population onto a reformed, deregulated set of insurance exchanges would be more disruptive than block-granting Medicaid (the traditional repeal-and-replace plank). I dont agree. The incomes of poor people tend to be quite volatile, leading to a high amount of churn between Medicaid and the exchanges. Migrating the Medicaid population onto the exchanges would offer them higher-quality coverage and care, with far less churn and disruption.
Done the right way, it would result in cleaner lines of responsibility between the states and the federal government. Paired with exchange-based Medicare reform, such an approach would substantially reduce federal spending while actually covering more people than Obamacare will. (For those who are interested in learning more about what a reform-based approach might look like, Doug Holtz-Eakin and I have sketched out the framework here and here. Stay tuned for an in-depth, white-paper treatment of the approach, via the Manhattan Institute, in several months time.)
I appreciate that continuing to embrace repeal has its galvanizing effects on our small slice of the electorate. And I agree that a good repeal-and-replace plan would be a dramatic improvement upon the status quo. But if we can shrink government by a comparable if not greater amount, in a way that is much more aligned with public sentiment (and therefore much more likely to actually become law), shouldnt we give it some thought?
It’s about as fixable and keepable in place, as the HMS Titanic is.
Repeal! Replace with freedom!
Here’s the problem. “Reform”, like “change” is a content free word. “Reform” means different things to different people. If reform meant “allow interstate insurance”, limit malpractice awards and lawyers fees for same, let people pick exactly what they want covered and not covered and priced accordingly, expand usage of MSAs. That would be fine for many, and would be a reform.
Reform for someone else could mean “The government pays for everything and taxes the rich man and corporations as much as necessary to get it”.
So these sizable chunks of polled people really represent two opposed positions. Yes, people want “reform”. There is no consensus on what kind of reform, and taking a Rube Goldberg piece of ... uh ... legislation DESIGNED to be unreadable and interpreted however Obama sees fit makes a poor base.
Sometimes you have to throw the old source code away before trying again. Of course, it may well not be worth trying again. Trying again means in 20 years we end up with Obamacare again, just like our formerly simple tax code became the present mess.
Considering how much money has been wasted on it already,does it make good sense to even think about fixing it? Remember,this is money we don’t have anyway.
Here are the pillars of this corrupt scheme. None of the minor fixes Republicans are discussing comes even close to sweeping away this corruption.
Navigators and assisters: Instead of government employees promoting ObamaCare and enrolling the uninsured, the law (Sec. 1311) reserves these jobs for community activists, unions, community health centers and other not-for-profits. Players include the NAACP, Planned Parenthood and Service Employees International Union. Hiring these groups is a way to fund the Democratic Partys shadow army between elections.
Assisters sign up the uninsured for non-health benefits and register them to vote. The National Association of Community Health Centers identifies voter registration as a key part of its mission.
The whole scheme recalls the days of Tammany Hall, when local ward bosses got the poor and newly arrived whatever they needed, in exchange for their votes. ObamaCare institutionalizes this corrupt model and pays for it with your premiums.
I don’t care what they call it. Get rid of it. Or at least get rid of the subsidies that are going to bust our budget.
The ACA is to health care what a sledge hammer is to a nail, or a flame thrower is to a cigarette.
The masthead should now read: 'Standing athwart history, and yelling, "slow down, just a tad" ... provided that 51% agree.'
Gawd how fallen are the mighty.
Nothing but blather from so-called conservatives.
NR died when Buckley did.
Remove all the Exceptions and Delays and then see if people want to keep Obamacare ? LOL
No matter how bad it gets, Obamacare will never die.
Too much money, too much power. The Feds will never give it up.