The GOP’s Healthcare Fail: Where Do We Go From Here?

March 24, 2017

by Maggie Gallagher


Paul Ryan has admitted he and the House Republicans failed bigly. He lacks the votes to repeal and replace Obamacare, so House Republicans and President Trump have decided to move on to other parts of Trump’s agenda that might prove more popular.

Ezra Klein is a liberal, but he hit the nail on the head about Paul Ryan and the Republican Party’s failure on Obamacare:

[T]he real problem Republicans are facing is that they don’t like their own bill. The Affordable Care Act survived its many, many near-death experiences because, fundamentally, Democrats believed in it, they wanted it to pass, and they thought it important enough to imperil (and ultimately sacrifice) their majority over.

The plan Paul Ryan built in secret has few friends. Conservatives think it leaves too much of Obamacare in place. Moderates blanch at the 24 million it will leave uninsured. Wonks shudder at its slipshod, hasty construction. Experts from all three of Washington’s major conservative think tanks — the American Enterprise Institute, the Heritage Foundation, and the Cato Institute — oppose it. The latest polling shows merely 17 percent of Americans support it.

This failure by House Republicans is a reminder of everything Republican voters hate about their own party as a governing party: years of promises and stalwart expression of conservative values, followed by years of inaction blamed on the Democrats. Except now, controlling both houses of Congress and the White House strips the GOP of any excuse for failing to act.

And yet, this bill deserved to die an ignominious death because Klein is right: not even Republicans liked it. It was the kind of compromise the GOP specializes in — small ideas that create a talking point but don’t actually solve the big problem, which in this case is not the cost of health insurance but the exploding costs of health care.

Health care is not going away as an issue, because Obamacare was designed to fail. It’s well along in its death spiral of rising costs. The GOP is going to have to address this issue before the 2018 elections or risk losing control to Democrats with whom Trump may well make a deal for nationalized health insurance. Who would then blame him?

Klein goes on to point out that the GOP’s decision to think small and try to win a talking point victory was not for the lack of big, exciting ideas on the table. The biggest and most exciting is some version of The Singapore Option.  Singapore is rated the 6th best health care system in the world, and it costs one-fourth of what the U.S. spends per capita and half what the national health insurance systems of Europe spend.

The core idea is to combine a universal catastrophic health insurance system with a mandatory health savings account (with an employer/employee match) that takes health care spending out of the hands of insurance companies and into the hands of patients and consumers — the same market forces that lead you to be able to get a bigger TV or a better video-gaming system at less cost every year.

No one is claiming such a system is an unregulated free market. It is licensed and regulated just as health care is now — for quality. It is heavily subsidized for poorer citizens, but it also lets extended families pool resources to cover unexpected medical costs for one of their members.

The GOP need to face now that it cannot simply walk away from health care. It needs to build a consensus around a system that will genuinely improve health care quality and reduce costs. The Singapore Option is the only one that fits the bill.

Without it, we are destined for the government-controlled national health insurance system we hate.

We know what works: putting power into the hands of the ultimate end users of health care and away from bureaucrats of the insurance or the government variety. We have an actual example of a high-quality health care system that has contained costs and improved health outcomes.

Republicans have a way. Do they have the will?

Photo credit: Gage Skidmore


Maggie Gallagher is a senior fellow at the American Principles Project.

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