It won’t kill anyone if the next steps involve political compromise.
“Compromise has an incredibly small constituency,” retiring Representative Trey Gowdy reflected in a parting-thoughts interview with Fox News Channel’s Martha McCallum. He lamented a prevailing, partisan mindset that it only takes 51 percent to govern.
Entering Congress by riding the Republican wave that followed the passage of the Patient Protection and Affordable Care Act without a single GOP vote, Gowdy in some sense owes his congressional career to the hyperpartisanship he laments. But that congressional career coinciding with the inability of his party to win over Democrats to repeal Obamacare during his tenure shows that one-way-street legislating eventually becomes a two-way street, with the closed-mindedness of one side begetting closed-mindedness on the other side.
This my-way-or-the-highway mentality becomes harder to maintain once the 116th Congress convenes with a Democratic House and Republican Senate. Yet, the country needs compromise now more than ever — particularly given a Friday night ruling that deemed Obamacare unconstitutional.
Healthcare, the issue Americans cited as their top concern in 2018 exit polls, remains broken. Americans pay more than double per capita what Frenchmen, Canadians, and Japanese pay — and experience worse results.
The Patient Protection and Affordable Care Act failed to make healthcare more affordable. Dissatisfaction presents itself in fewer people signed up, barring some incredible last-minute surge by Saturday’s deadline, for the Affordable Care Act’s federal “marketplace” than did last year. Even Democrat discontent with Obamacare manifests itself, most notably through the popularity of single-payer plans endorsed by Bernie Sanders, Cory Booker, Elizabeth Warren, and other presidential hopefuls. If Obamacare fixed healthcare, why so many proposed fixes?
Nobody full-throatedly defends Obamacare. Nobody goes to the mat to repeal it, either.
And maybe nobody in Congress needs to. On Friday evening, Judge Reed O’Connor ruled Obamacare unconstitutional. “In sum, the Individual Mandate ‘is so interwoven with [the Affordable Care Act’s] regulations that they cannot be separated,” the federal judge ruled in response to a lawsuit brought against the feds by 20 states. “None of them can stand.’”
Whether his opinion stands or not, Obamacare surely falls. It falls because it fails to do what it purports to do. It makes healthcare more expensive, not more affordable.
How might Democrats and Republicans come together to improve American healthcare? It starts with acknowledgement that their constituents regard out-of-control costs as the primary malady. This inflates the debt, which soon hits $22 trillion (more than U.S. gross domestic product), drags down the economy (big businesses pay more than $10,000 on healthcare per worker annually), bankrupts citizens, and limits the flexibility of legislators regarding both taxes and spending.
A fix requires give-and-take, a concept mostly foreign to scribes but essential to legislators. This means understanding that the approach to healthcare reform does not approximate the ideal. But the current healthcare regime falls so far short of perfect. Improvement, not idealism, should govern the fix. In alleviating what ails us, three principles should guide:
1. Competition benefits everyone. Any reform of healthcare should recognize that the move away from a market model corresponded with massive price inflation. In the market, competition reduces prices and improves existing products. The holiday shopping season makes it hard to escape from this truth. The increased involvement of Amazon and other tech giants in healthcare means more competition — good news for consumers.
2. Medicaid requires major surgery. Medicaid would be more efficient if used for vouchers to pay for private insurance. Short of this, merging the wasteful welfare program with the more streamlined Medicare entitlement could save money and please progressives seeking more equality in funding. Rather than beneficiaries drawing on vastly different benefits in, say, Mississippi and Massachusetts, need instead of geography could dictate benefits.
3. Third-party payers, whether private insurers or public programs, inflate cost. When people pay, even a portion of costs, they remain mindful of costs. When third parties pick up the tab, the tab grows. This is common sense. Though individuals naturally dread copays, premiums, and bills, the lack of all that stands as a major reason why we pay 18 percent of our gross domestic product on healthcare.
Republicans punted after failing to reform healthcare on multiple downs in 2016. Democrats continue to offer pie-in-the-sky schemes to reform healthcare. A judge in Texas may have just forced both parties to replace rhetoric with realistic action — and action that requires the compromise that Trey Gowdy found missing in action during his time on Capitol Hill.
Hunt Lawrence is a New York-based investor. Daniel Flynn is the author of six books.