From Rinse and Repeat to Reshuffle and Redeal: The Problems with Graham-Cassidy
by D.J. McGuire
Republicans keep telling me that being a conservative Democrat will be difficult, and yet they continue to make it easier. The latest example of this is the Graham-Cassidy bill, which is ostensibly the latest Obamacare “repeal and replace” effort coming from the GOP.
Just to recap, the first “repeal and replace” turned out to be nothing but an airy slogan. Then came the AHCA, which can be best described as “rinse and repeat”. Now, we have Graham–Cassidy, which can be best described as “reshuffle and redeal”.
The Graham-Cassidy bill boils down to two major parts: a repeal of numerous regulations, and the shifting of subsidies that would go to state capitals instead of insurers. States would also have greater control over Medicaid funds they receive.
Now, I’m all for removing the insurance “mandates”. The taxes used to enforce them are too small. Moreover, tax deductions or credits are more aligned with the deductions employers get for group insurance, while providing better incentives for individuals to buy insurance without adding to Washington’s coffers. However, no such changes are in this bill, which is its first problem.
The second problem is that the bill would exacerbate a predicament already afflicting the country: too much state-level interference and health insurance and healthcare markets. While I have discussed before how the rest of the world is far from unanimous about “single-payer”, they all do use their national governments to establish rules, minimums, etc. States already have too much power in these areas, and they normally use it more to restrict markets then to enhance them – such as Certificate of Public Need regimes and a lack of energy for serious tort reform.
This brings us to the final and most important problem with the bill: its singular focus on health insurance at the expense of healthcare. Once again, Republicans in Washington seem completely uninterested in trying to encourage more doctors and nurses to enter this country, or to encourage more Americans to become doctors and nurses, or to help clear out the economic regulations that get in the way of developing and building healthcare facilities (such as COPN).
The result of the bill, should it be enacted, is fairly easy to see. Any reduction in federal regulation will simply be countered by likely increases in state regulation. Even if one assumes fedERAL funding would remain stable – and there is no reason to assume that at all – that will not guarantee stability among the number of insured (given that state capitals are more involved). So we can expect fewer acquiring health insurance, and no real improvement in health care.
Graham-Cassidy does nothing to address the actual market failures in health insurance and healthcare, while creating greater opportunities for government failure. In short, Reshuffle and Redeal is no better than Rinse or Repeat, or “Repeal and Replace.”
I still await Washington’s willingness to consider Rethink and Reform.
D.J. McGuire is the conservative Democrat on More Perfect Union podcast – and sometimes feels like he is the lone conservative Democrat in the country.