Republicans Are Losing the Healthcare War to 'Win' a Battle

Republicans Are Losing the Healthcare War to 'Win' a Battle
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The American Health Care Act (AHCA) has been proposed by House Republican leaders as a way to repeal and replace the Affordable Care Act (Obamacare). The plan was met with derision on the left and from much of the right. Liberals simply want to preserve Obamacare or expand it, so a plan to repeal and replace it with anything short of universal, single-payer nationalized healthcare will fail to gain support from Democrats. Conservative Republicans dislike the plan because it replaces Obamacare subsidies with refundable tax credits and leaves too many federal regulations in place. They believe the leadership is losing the war in order to win a battle.

The battle in question is the repeal of Obamacare. Republicans in Congress and President Trump ran campaigns based heavily on a promise to repeal Obamacare and so they are all committed to accomplishing that feat before the 2018 midterm elections.

The war being surrendered concerns if the federal government should be in the business of subsidizing health insurance in some manner. This question turns on whether healthcare is a human right, something everyone is entitled to access.

Most of the conservatives who are opposing Mr. Trump and Mr. Ryan oppose the concept that simply because one group of people desire healthcare without paying for it they have a claim on the property (wealth, time) of another group. In this, they are being consistent with the Constitution. In American history, the original view was that public funds could only go to pay for things directly related to the general welfare, such as national defense.

This view lost its first big battle with the New Deal. Since then, it has been eighty years of nearly continual expansion of both the welfare state and the role of the federal government as a redistribution mechanism. Today, 70 percent of federal government spending is nothing more than taking money from one person or company and giving it to another.

This is the war the conservatives are supposed to be fighting. To borrow from the left’s nomenclature, the conservatives should be resisting the expansion of the redistributive state. Conservatives see the AHCA as simply putting a tiny bit of free market spin on a continuation of a massive increase in redistribution to fund healthcare. Worse, this is not a social safety that helps people temporarily when they need it, but rather would be providing wealth transfers to tens of millions, many of whom would be collecting the money forever. If you don’t get health insurance through your employer, you can get a refundable tax credit for health insurance, regardless of income level.

What has conservatives upset is that House Republicans along with President Trump seem to be perfectly content to surrender the argument over principles without a fight. Many of the same politicians who fought against Obamacare on this very principle now seem willing to concede the principle as long as they can claim to have repealed Obamacare and replaced it with something they can spin as more free market in its implementation.

The only reason to be more concerned about winning the battle than the war is concern over re-election. Senator Rand Paul and others have called for a simple repeal of Obamacare, deferring the question of how, or if, to replace it. This would be winning the battle while also preserving the chance to win the war on principle.

It appears some Republicans are opposed to this approach because they fear that too many Americans have now become accustomed to the Obamacare subsidies; they believe the war is already lost and all that is left to win is the battle. I don’t believe this to be true. Conservative voters who powered Mr. Trump to victory need to convince Republicans in Congress that they are not willing to accept the tradeoff of sacrificing their small government principles so that some politicians can claim to have kept a campaign promise. What is being proposed with the AHCA is not what many voters understood that promise to be.

Jeffrey Dorfman is a professor of economics at the University of Georgia, and the author of the e-book, Ending the Era of the Free Lunch

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