House Speaker Paul Ryan is up to his old tricks again...
The same guy who loved to criticize Donald Trump during the 2016 campaign, and who caved to Barack Obama repeatedly on budget deals, is now doing his best John Boehner by trying to pass watered down legislation, i.e., The American Health Care Act (AHCA). But this so-called "good start" to repealing and replacing Obamacare is weak and misguided.
AHCA keeps in place the mandate to buy health insurance, maintains subsidies, throws more money at Medicaid, does not eliminate the monopoly-like stranglehold insurance companies have due to the restriction against selling policies across state lines, and leaves in place a tangle of onerous regulations.
Perhaps worst of all, AHCA buys into the notion that the federal government ought to retain its front-and-center role in subsidizing and micromanaging health care. Excessive regulation and micromanagement -- the Centers for Medicare & Medicaid Services is Exhibit A -- are a primary reason why health care is such a mess. Liability lawsuits and insurance premiums are another culprit, but that's a topic for another day.
Ever take a look at the minutiae the regulators deal with? Things like physician fee schedules, relative value units, the "resource-based relative value system" and other mind-numbing criteria? It's a witches brew of mischief and turmoil that stifles market forces and distorts the market.
People complain about the proverbial $30 aspirin or $80 for a bandage, not to mention the $1,000-$2,000 per day costs of a hospital room. But health care providers getting squeezed by Uncle Sam on one front -- providing certain procedures to Medicare and Medicaid patients at ridiculously low prices -- have to make up that revenue shortfall by charging more for other goods and services. Not to mention, patients are having greater difficulty even finding clinics that accept Medicare or Medicaid due to these programs' pitiful reimbursement rates.
A solid group of conservatives in the U.S. House is opposed to the Ryan plan, and believes he can achieve much more than he's shooting for through the budget reconciliation process. The process, which Democrats used to pass Obamacare seven years ago, does not require 60 votes to overcome a filibuster. It simply requires majority vote.
But in order to qualify for this process, the legislation in question has to have fiscal ramifications. Ryan claims the insurance sales across state lines and an effort to repeal regulations don't qualify for this standard. But stop and think of it: Insurance companies pay taxes and fees, and their rates and policies affect the size of subsidies. So this matter is rich with revenue and budgetary ramifications. Ditto for taking the scalpel to regulations, which are another hidden cost that manifests itself in the $15 Tylenol pill or stitches that cost $500 apiece.
Let's hope the conservatives in the House and Senate will hold strong, and that President Trump keeps his promise to strike a bargain. He has at least been willing to meet with the conservatives and hear them out, and that's a great sign.
Ryan and the rest of the Republicans must realize that they have a limited window of opportunity to enact effective legislation. If they blow this opportunity or foolishly try to court Democrat votes, they will pay a heavy price.