Republicans in Congress have not given up on altering our health care system, and the White House is prepared to go along for the ride. Unfortunately, the new bill, led by Reps. Bill Cassidy, R.-La., and Lindsey Graham, R-S.C., is too hasty and too risky to merit support.
Rather than scrambling at this late date on the legislative calendar to come up with a “win,” Republicans would be better off acknowledging the difficulty of serious reform, playing the long game, and crafting and debating a more evenhanded and even-keeled proposal.
Despite its flaws, the new bill has a certain logic and elegance to it. Under Cassidy-Graham, Obamacare would give way to a federalistic system where each state is allowed in theory to adopt whatever regime it prefers — from a full-blown free-market approach to the kind of single-payer system now overwhelmingly favored by Democrats.
The bill seems to concede that, despite years of trying (or saying they’re trying), Republicans just can’t seem to repeal and replace Obamacare with something better and more viable. If Congress can’t deliver, the bill all but says, surely the American people can settle on legitimate solutions by using their respective states as the laboratories of democracy they were intended to be.
Perhaps. But beneath the ideal lurk several fatal difficulties. For starters, the bill is actually primed to discriminate against states with free-market hopes. While Democrats favoring single-payer can achieve that result at a stroke, Republicans hoping to liberate their state from Obamacare once and for all would have to submit themselves to a protracted and inauspicious process of applying for regulatory waivers from the federal Centers for Medicare and Medicaid Services. A Republican president might help block some tackles. But what about a Democrat?
Not only Republicans have reason for skepticism, however. If Cassidy-Graham were implemented nationwide, Democrats would fairly complain that the flow of subsidized care would shift from blue states with more healthy populations and broader coverage to red states with sicker and less covered ones.
Worse, while Obamacare’s coverage mandate would go, its pre-existing condition rules would stay. That combination would drive healthy people out, making it impossible to pool risk across a wide enough cross-section of insureds — with the likely result a series of “death spirals” in insurance markets.
That problem would be exacerbated in states where…