Will the real moderate party please stand up?
On the same day that socialist Sen. Bernie Sanders (I-Vt.) introduced his "Medicare for All" healthcare plan, Sens. Lindsay Graham (R-S.C.) and Bill Cassidy (R-La.) introduced a last ditch effort to sorta-kinda repeal and replace Obamacare. Despite having zero chance of being passed any time soon, Sanders' bill grabbed the limelight for two reasons.
First, it's a beacon of hope for the demoralized base. As a Rolling Stone headline put it, "Single-Payer Movement Shows: Life After Trump May Not Suck." Second, Sanders got 15 co-sponsors – including some Democratic senators with presidential ambitions. The fact that so many contenders signed on to a bill that, if enacted, would throw 100 million Americans off their employer-provided healthcare and cost taxpayers an estimated $32 trillion over a decade, revealed just how far to the left the Democratic Party has moved.
And yet, to listen to Democrats and many of the journalists who love them, you'd think it was the Republican proposal that's extreme. "In reality, Graham-Cassidy is the opposite of moderate," New York Times columnist Paul Krugman pronounced. "It contains, in exaggerated and almost caricature form, all the elements that made previous Republican proposals so cruel and destructive." The news section was more even-handed: "Medicare for All or State Control: Health Care Plans Go to Extremes."
Are they really both "extreme"? Graham-Cassidy's chief goal is to pare back the federalization of healthcare policy by getting rid of the individual and employer insurance mandates and letting governors waive out of some regulations. More important, it block grants Medicaid, a long sought dream for those wanting to get a handle on out-of-control spending and debt.
A main driver of exploding healthcare costs has been the way the federal reimbursement system discourages thrift. And Obamacare made that problem much worse. Under Obamacare, Medicaid rolls were vastly expanded, adding millions to a faltering program. And in order to seduce states into signing up, the Feds promised to cover 100% off the additional costs for the first three years and no less than 90% in later years. If you had an expense account where someone else covered most of the tab, how eager would you be to control costs?
By giving states a lump sum, the hope is they would experiment with cost-saving reforms that improve healthcare results. Opponents of giving states the money and flexibility to innovate often seem to work from the assumption that governors and state legislatures want to harm their own citizens.
Graham-Cassidy is by no means perfect and odds are it won't pass. Democrats are locked into the position that healthcare reforms can only involve more government spending and regulation. With only 52 GOP senators, it can only pass if at least 50 of them vote for it, and they must do so before Sept. 30, when the arcane budget window known as "reconciliation" closes. Because some Republican states would lose money on the deal, squishy senators including Alaska's Lisa Murkowski might balk, as she did with previous attempts. This is why it would be smart to emulate Obamacare (and welfare reform) and be overly generous upfront with the block grants, to essentially bribe politicians into voting for it.
Meanwhile, Kentucky Sen. Rand Paul, who has mastered the art of supporting the status quo by voting against piecemeal improvements in the name of purity, has already indicated he will continue to play that game.
Heritage Action has grumbled, rightly, that Graham-Cassidy doesn't repeal all of the Obamacare taxes. But the choice for Republicans isn't between this and a better reform. It's between this or letting Obamacare continue intact, violating all of those repeal-and-replace promises entirely.
That's what's so silly about the claim that Graham-Cassidy is as "extreme" as Sanders' radical and shoddily written proposal (the bill is totally silent on how to pay for any of it). Graham-Cassidy is very close to the kind of legislation we would have ended up with if Republicans had an idea of what they wanted from the get-go and the Democrats were interested in compromise. But we live in a time when extremism is defined as not getting everything you want.