On Politics: Graham-Cassidy Amendment ‘least bad’ for health care
October 5, 2017
"Repeal and replace Obamacare" was the GOP mantra for at least seven years. They even cobbled together majorities in both houses of Congress riding the "repeal and replace" horse and proceeded to pass legislation implementing exactly what they preached knowing it would be vetoed by then-President Barack Obama.
In 2016, an unprecedented 17 GOP candidates for U.S. president rode into town, each on his or her own "repeal and replace" steed, and the herd was winnowed down to Donald J. Trump. Finally, the stars were aligned to "repeal and replace," but the whole thing bogged down in the Senate.
Why? Because health care affects everybody and legislation that would change the status quo is going to benefit some and hurt others. It didn't help that the Senate GOP Caucus had a few prima donnas and couldn't function cohesively.
Democrats ruled the roost in 2009. Obama was president and both houses had large Democrat majorities, yet high-priced lobbyists for big pharmaceuticals, big medicine, and big insurance pretty much shaped the Obamacare legislation.
So, as Obamacare begins to crumble, what system of health care would deliver medical services at prices consumers can actually afford? Vermont Sen. Bernie Sanders is waiting in the wings with a single-payer plan called "The Medicare for All Act of 2017," which would provide "free health care" for everybody.
The measure would cover doctor visits, drugs, home care, specialty care, dental care, and vision care. There would be no deductibles, no co-payments and no coverage caps. The measure does not include any funding mechanism, but Sanders wrote a separate white paper suggesting that the top income tax bracket could be raised to 52 percent, a 4 percent health care tax could be imposed on households, a 7.5 percent payroll tax implemented, and a few others. The Urban Institute estimates the cost of Sanders' plan at $32 trillion dollars, so "free health care" would not be free.
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The GOP "repeal and replace" plan, which died aborning, would have actually amended Obamacare to cut back on Medicaid (single payer) expansion, allow insurers to price health care plans for those with pre-existing conditions at market, and eliminate the mandate that every citizen carry government approved health insurance or pay an annual fine (sorry, that's unconstitutional, let's call it a "tax").
So, Democrats would financially cripple any person or business that actually pays taxes in order to furnish "free" health care to everyone, including those who don't pay taxes. Republicans would leave some 156 million employer-insured Americans alone and control costs by curtailing subsidized health coverage for the poor and unemployed. What a quandary.
Here's the moral of the story: there is no single "good" answer. Either way, some strata of Americans will get hurt so the challenge is to find the "least bad" answer.
I would nominate the Graham-Cassidy Amendment for the "least bad" role. Why? Because it would delegate most decision-making individually to the 50 states, just like you're supposed to in a Republic. So, instead of the little guy getting screwed by special interest Washington lobbyists, the battlefield becomes localized where we can twist the arms of our state assemblymen and senators to look out for our interests.
Graham-Cassidy would appropriate about $1.2 trillion and send it to the states on a per capita basis, so they could each adopt their own health plans. That's about $30.8 trillion less than Sanders' measure. (Canada, by the way, has socialized medicine but funds are distributed to and decisions delegated to its provinces).
Graham-Cassidy would encourage health savings accounts through tax benefits, and allow states to require able-bodied Medicaid recipients to work as a condition of receiving benefits. As a political sop to conservative evangelicals, the measure would defund Planned Parenthood but nobody said the bill was perfect — just "least bad."
Jim Clark is president of Republican Advocates. He has served on the Washoe County and Nevada GOP Central Committees. He can be reached at email@example.com.
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