For some reason, Republicans want to delay Obamacare repeal for three years. The Manhattan Project detonated the world’s first nuclear bomb in less time, but the U.S. healthcare industry supposedly needs 36 months to go back to how things were six years ago.
The real issue seems to be that Republicans can’t agree with each other on what the “replacement” bill will be. At some point in the last few years, the political consultant class decided you’re not allowed to discuss repealing the current monstrosity without smiling and promising to replace it with your own version, except nobody can agree what the GOP idea is for a federal health care system.
You have to ask yourself, if Republicans couldn’t agree over the last eight years of the Obama administration on a replacement bill, what do they think three more years is going to accomplish? It’s not like there’s an easy solution, it’s just nobody had time to deal with it yet because there were more pressing matters. Many Republicans spent many hours diligently working on a health care bill, but every effort fell apart in acrimony.
The big problem with waiting for three years is the law has plenty of terrible things in store before then.
For example, the law’s rationing mechanism — officially called “Independent Payment Advisory Board” or, colloquially, the Obamacare “death panels” — is still in place and threatens to cause major damage to the health care system.
IPAB is designed to take authority from elected officials and place it in the hands of unelected bureaucrats at the Department of Health and Human Services. Its purpose is to shield the rationing decisions from public accountability.
For example, the law makes it illegal for the president to fire any of the panel’s members. And Obamacare actually tries to prohibit any future Congress from repealing IPAB, something that is brazenly unconstitutional but has yet to be adjudicated in court.
Another pernicious aspect of IPAB is that it prohibits the board from touching any liberal sacred cows, essentially channeling its rationing decisions in a left-wing direction. The choice that’s left for the board is deciding which price controls they want, which is convenient since liberals wanted price controls in the first place, they just couldn’t put them directly in the law.
Finally, although the law envisions IPAB as a panel of experts, if the president fails to appoint those members, all of its authority falls to the Secretary of HHS, entrusting the power to rewrite the law in a single person. Since Obama has yet to even try to nominate the board’s members, that appears to have been the plan all along.
To summarize, Obamacare has set in motion a board of unelected bureaucrats tasked with establishing price controls on autopilot. Are we supposed to just watch the train wreck, while Republicans debate the finer points of health care policy for three years?
The obvious solution is to start with the easy stuff. It’s like What About Bob? – “baby steps.” Contrary to conventional wisdom, that doesn’t make it any harder to do the big lift later on. Actually, it becomes easier, because early wins are helpful practice and build momentum. The Trump-Ryan-McConnell team is going to need some time, before they’re at the top of their game.
Politically, this is a no-brainer. It’d be hard to make a case that any provision in the law is more reviled than IPAB. There’s no infamy quite like “death panel.”
Republicans in Congress, this is not the time to dither. IPAB repeal cannot wait for three long years. Do it now, in Trump’s first 100 days.