Enough flim-flam: move on now to solve health care puzzle

When the Senate majority leader wields the possibility of bipartisanship as a threat and dismisses massive cuts to Medicaid as a shell game, you know it’s time to move on.

Sen. Mitch McConnell’s desperate scramble for one or two more votes to repeal and replace the Affordable Care Act has actually reached those moral depths. And it isn’t working for congressional Republicans, let alone the American people.

Over the weekend, he once again postponed a vote on the Senate bill, but even if he does somehow cobble together 50 votes, the House and Senate versions must be merged. That would require even more McConnell machinations, but it’s difficult to imagine how he could come up with any more shameless than those two.

After Republican senators could not reach agreement in a meeting at the White House before their July 4 holiday, McConnell grimly summoned the specter of bipartisanship, warning, “Either Republicans will agree to change the status quo … or we’ll have to sit down with (Democratic minority leader Chuck) Schumer.” Oh, the horror!

Then, last week, in a session with moderate GOP senators worried about the replacement bill’s drastic cuts in Medicaid, which helps millions of their poorer constituents buy coverage, he pointed out that most of those cuts aren’t scheduled until 2026 and “they’ll never go into effect anyway” because members could always change their minds.

The deeply cynical import of those words: just pass something, anything that looks vaguely like repeal and replace, because we can always renege on it later.

So before the political rot gets any worse, it’s in the best interest of both parties, and certainly of all Americans, to kick the repeal-and-replace habit that has narcotized the GOP for seven years and substitute “fix health care.”

The first symbolic but crucial recovery step is to drop the freighted epithet “Obamacare.”

The second step for everybody — all parties, all ideologies — is to accept five realities:

▪ Health care is not a free market and can never work like one. Free-market transactions require a willing seller and a willing buyer. Sick people are not willing buyers; dying people have no bargaining leverage.

▪ Health care is more than a matched pairing of buyer and seller. It is three, not two, distinct entities: users, insurers and providers. Each has its own requirements, goals and guiding principles which often conflict. Therefor some compromise of the core interests of each is essential to maintaining viability for all.

▪ To survive and provide coverage at affordable rates, insurance companies must have a client pool containing sick people and well people. That will never happen voluntarily. There must be a legal requirement or other effective incentive to enroll everyone.

▪ The far right must abandon the idea that government has no legitimate role in health insurance. The far left must realize it can’t get to a single-player plan right now.

▪ Curb the rhetoric. The ACA is not in a “death spiral.” Health care conservatives are not heartless ideologues. Liberals don’t crave “socialized medicine” or want to subvert democracy.

Then get to work — together and in public. Forgive and forget the foolish “kill Obamacare” pledges and the seven years of potential progress they wasted. Forget tax reform for now. Move on, but forget being quick about it. Listen to the insurers, the providers, the insured. Get health care right.

This story was originally published July 18, 2017 at 5:00 AM with the headline "Enough flim-flam: move on now to solve health care puzzle."