The Donald Trump era has made Washington D.C. a little more entertaining, but has done little to change how the Beltway operates. Democrats still hate Republicans, Republicans still hate leadership, and Wall Street still controls the Treasury. So it goes.
As such, when I had heard that a last second Obamacare reform bill had come out, I had assumed that – like Ryancare, “Skinny Repeal”, and other such gimmicks – we were dealing with another Obamacare-lite measure that did little more than paint Obama’s legislative nightmare red.
To my great surprise, I was wrong. While far from being my ideal bill, the Graham-Cassidy-Heller-Johnson Plan is one of the most impressive reforms of its scale that has been proposed in a long time.
From the beginning, the most important benchmark I’ve had in judging healthcare reform is how it handled the individual mandate. Not only am I repulsed by the idea of government having the power to mandate you purchase a product simply because you exist, but the mandate undermines one of the most important developments in American healthcare: the growth of the direct primary care model.
By breaking away from the shackles of insurance made unbearable by Obamacare, doctors have increasingly been returning to old-fashioned approach of dealing directly with their patients. Most charge a simple flat free for near-unlimited access to basic services. This means less paperwork, less restrictions, less cost.
Of course, those who currently use such services either still must have costly ACA-compliant health insurance plans, or pay for it when it is time. This is wrong, and if Graham-Cassidy did nothing more than repeal this tax, the bill would be deserving of support.
That’s why I can’t understand why Rand Paul remains committed to stand with Chuck Schumer, Elizabeth Warren, and Susan Collins in opposition to this bill. Listening to the Senator defend his position, it’s not clear he understands why either.
At first, the Senator tried to claim that this bill kept 90 percent of Obamacare. This was simply incorrect, which is why he now talks about “90 percent of the spending and taxes of Obamacare.” This is closer to the truth but surely, as a supporter of the “Penny Plan,” Senator Paul could agree that modest real cuts in spending are better than no cuts at all. Further, the tax cuts included in the bill are some of the most immoral parts of Obamacare, making patients pay more for prescriptions and medical devices.
When pushed further, Senator Paul tries to dismiss Graham-Cassidy’s block grant approach by mocking the notion that states would be any better at running Obamacare than the feds do. Not only does the Senator blatantly misrepresent the power Graham-Cassidy offers states in crafting their own programs, but the superiority of a decentralized model over a single Washington monolith should be obvious to a legislator who constantly – and correctly – highlights the advantage of federalism.
Further, if we move past ideals and instead focus on realpolitik, kicking important decisions to states would be a huge advantage to Paul’s small government allies who have proven to have more influence in various state legislative chambers than they’ve ever managed in the beltway.
Is Graham-Cassidy a silver bullet for all that woes American healthcare? Of course not. But neither was Rand Paul’s own proposal. Washington has spent 100 years screwing up healthcare, and it’s going to take more than a single bill to fix it.
Instead of trying to fix Federal policy that may very well be unsalvageable, the focus for Paul and other reformers should be empowering Americans to opt out of bad programs, rather than fixing them. That should be true for healthcare, education, social security, and even money.
By eliminating the individual mandate and helping empower direct primary care providers, Graham-Cassidy passes that test. Hopefully Senator Paul can come to understand that, and save this bill.