Saturday, March 25, 2017

After the End

At National Review, I have some thoughts about the failure of the vote on the American Health Care Act:

The death of the American Health Care Act has been greatly exaggerated — not because it is likely to be revived (at least in its current form) but because it might never have really been alive in the first place.
Many of the provisions of the bill were unlikely to survive contact with the Senate, and there was a very strong chance that the bill that was released from a House–Senate conference would radically differ from the AHCA. Perhaps realizing the limits of the AHCA, some defenders of the AHCA supported the measure principally as a way of getting to conference. However, there is no reason to believe that the tensions that pulled down the AHCA on Friday would not similarly undo the resulting House–Senate conference bill. Some Republicans would still be upset that the conference bill was not a full repeal of the Affordable Care Act, and moderates (along with some populists) would be pulled into a tug-of-war with budget-cutters over the size of Medicaid cuts.
You can read the rest over there, but I'll make a few general points here.

This is not necessarily a CATACLYSMIC DEFEAT for President Trump or congressional Republicans.  The real political risks of the bill had it passed (such as cuts to health-care subsidies for the working class) in part explain why it failed to pass the House.  The defeat of the bill gives Republicans a chance to start health-care reform over again or to turn to other issues.

That said, the debate over the AHCA did highlight real divides within the Republican coalition.  Some of these divides (such as populists v. budget-cutters) will have to be at least partially overcome if Republicans hope to pass major pieces of legislation.  Two important words will be compromise and imagination.

If there is to be another Republican effort at health-care reform, policymakers might find it wise to prioritize reforms to help drive down the cost of health care through making the medical system more nimble and responsive to consumers.

Some other interesting responses to the fall of the AHCA: Reihan Salam says that we shouldn't blame the Freedom Caucus for the AHCA's failure.  Pascal-Emmanuel Gobry recommends the following course of action for conservatives on health care:"Slash regulations. And then subsidize health care."   Tim Alberta narrates the fall of the AHCA.  Ben Domenech thinks that congressional leaders need to embrace transparency in the crafting of legislation.

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