Sadly, thanks to the GOP’s handling of this fine mess, so too are many Senate Republicans’ reputations—for being serious individuals, for having a conservative bone in their body, and for taking health care policy seriously.
But there’s a small bit of good news in all this, if you look very, very, very closely.
Yes, the criticisms of the bill from the likes of Senators Mike Lee, Ron Johnson, Ted Cruz, and of course Sen. Rand Paul were all dead-on and exposed the absurdity of their colleagues claiming to be anti-Obamacare while trying to advance a bill that could most charitably be described as an Obamacare “reform” bill and was more accurately dubbed a Medicaid overhaul package.
Yes, too many people who have for years railed against the vast government overreach in Obamacare showed themselves willing to settle for just slightly less government intervention in the health care space, done in such a way as to deliver nominal, dubious improvements for some of the population.
Yes, many Senate Republicans should just be counting themselves damned lucky that they’re incumbents from deep red states, and/or not up for re-election.
But if they choose to take advantage of one small thing, evident from all this Obamacare non-repealing, they might just salvage their reputations as castrated weasels undeserving of love from their base, nor votes from the masses.
Note this: Badly crafted, unconservative, and unpopular though the Senate proposal might have been, its pursuit did demonstrate that Republicans are willing to buck big, entrenched health care industry interests rather than just doing what the big dogs with the money and the power in the nation’s capital want. No, really, it did—and that might actually be the most extraordinary and hope-inspiring thing about this whole debacle.
The American Medical Association—widely regarded to those of us in the Beltway consultant class as one of the three most powerful trade associations in town—opposed the Senate bill, and yet the majority of Republican Senators appeared to be just fine with sticking with it.
The American Hospital Association also opposed it. So did specific medical practice lobbying entities, like the American Psychiatric Association and the American Academy of Pediatrics, and what some in town colloquially refer to as the “body parts” groups—organizations like the American Heart Association and the American Lung Association. Those groups have muscle, albeit less than the AMA. Some GOP senators were also unmoved by the opposition from the U.S. Conference of Catholic Bishops.
Arguably the biggest surprise, however, and the thing that most indicated the existence of some cojones was that Republicans were prepared to run afoul of AARP in a big way. As everyone knows, older voters are the most bankable in the GOP fold—and 2016 was no exception on that front. AARP boasts 38 million members, and the organization has reportedly seen big jumps in membership as Obamacare repeal has advanced. Giving AARP the shaft wasn’t actually a yellow-bellied move, just as pissing off the AMA evidenced some tolerance for political risk. It took some gumption, albeit less than crossing the organization on Medicare cuts or privatizing Social Security would.
This matters because if Republican senators, gutless creatures that they are, were willing to alienate the AMA, AHA, AARP, and so on over a lame Obamacare-tweaking deal, there’s a chance—just a small one—that they might be willing to alienate them by doing things that look less dramatic, but could have a more consequential effect while adhering better to free market ideology.
One such idea might be medical pricing transparency. Many doctors and companies that perform testing hate this idea, probably because pricing obscurity enables them to charge higher prices, and bill insurance instead of the patient directly. This is a problem I’ve experienced firsthand, with regard to a test that would have cost me $400 out of pocket (and for which I could have sought reimbursement), but was billed to my insurance company for closer to $1,500. Practices like that make health care, and insurance, too expensive. Maybe if senators would buck the AMA on Obamacare “repeal,” they’d buck AMA constituents who oppose transparency on this kind of thing, too (though it’s worth noting that some of their state-level colleagues have not when given the chance).
Another might be re-upping legislation designed to move everyone in the country onto the same system of freer market health care—a goal we’d have made some progress toward if Paul Ryan’s doomed Medicare premium support plan had ever made it into law. It is, at minimum, arguable that having some Americans on Medicare, some on private insurance, some on Medicaid, and some paying out of pocket leads to a situation where cost savings achieved with regard to one group can be offset by price increases levied on another. It seems at least plausible that this is not conductive to bending the cost curve, and keeping health care inflation in greater check.
And yes, a third idea might be reform that actually aims to reduce the amount that everyone is spending on health care by somehow diminishing the ample opportunities that currently exist for providers, hospitals, testing facilities and so on to bill the highest conceivable amount for any given service, consultation, prescription, procedure, or so on, that could be argued necessary. There are mechanisms for doing this, though apparently insufficient testicular fortitude exists to do this at present.
Undoubtedly, health care policy wonks could think of others that might just pass muster from an ideological stance, and a vote-counting perspective, if only Republicans can maintain a small bit of the gumption they’ve shown in giving some of these lobbies the proverbial finger over these recent weeks.
But don’t get your hopes up… this is Washington, D.C., and the GOP, after all.