Just a First Step, But a Big One

Well, on a second attempt, Trump and the Republican House finally did it.  They proved that at least when the chips are down, they can piece together some semblance of a governing majority.  So now what’s next for Obamacare?  Or maybe that name no longer should apply, because one thing is sure–the Republicans now own the health care system, for better or worse.  And remember, the Democrats also passed their bill in 2010 without a single Republican vote and it cost them control of the House.  The Republicans now face the same fate if they cannot properly shape the message, make the case for a big change in direction from current law, and overcome the tsunami of demagoguery that will ensue on a daily basis from now through the 2018 election cycle.  And it’s now on to the Senate, where a completely different procedural protocol will come into play.  So the win in the House was big, but just a first step.

The Wall Street Journal is calling the House bill “the largest entitlement reform in decades by devolving control over Medicaid to the states” and “a giant step away from the Democratic march to government-run health care”.  Well, yes maybe, but as I have noted, the problem now is that the fulcrum of the debate has shifted since 2010–this bill now represents an entitlement being taken away, and almost totally missing from the messaging is the appeal to a return to a completely market-based health care system.  Obamacare is now the status quo, Medicaid is the de facto safety net, and the default position is that health care is a right, not an allocation of the market place.

So the opportunity is there and the debate has now been seriously engaged, but the GOP has not yet made the case to the American people, and Trump tweets will not be nearly enough.  The choice couldn’t be more clear–either Republicans vote for what comes out of the upcoming House/Senate conference or a single payer health care system is only one election away.  Joe Biden was right–this is a big deal.