Health care reform is a complicated topic, but explaining why Ryan’s health care proposal failed is not.
With all its flaws, Obamacare has forever changed public expectations about healthcare. It’s now unconscionable to expect average Americans to take financial responsibility for their own coverage. Insurance companies are expected to eat losses from consumers with preexisting conditions. Older pre-Medicare Americans shouldn’t have to shoulder the burden of additional health care costs associated with age. Somehow government is supposed to subsidize all of this with a magic wand and additional taxes on “the rich.”
The current mess can only be fixed with a strong dose of free enterprise that requires consumers to budget, make choices, and accept personal responsibility. Many Republicans are too squeamish to back this type of serious reform, so Paul Ryan developed a package of marginal improvements that he thought would placate the moderates. He didn’t figure there would be enough principled Republicans unwilling to accept a dubious promise about more serious changes in phases 2 and 3. He miscalculated.
President Trump had little to do with Ryancare’s failure. It’s just a numbers game. Democrats will oppose any repeal, so the Republicans need to stick together. Moderate Republicans will likely reject a strong market-oriented plan like the one Rand Paul developed. Liberty-minded Republicans have already demonstrated their unwillingness to support a proposal and tweaks the current system. Threading the needle with a compromise acceptable to both ends of the party is not impossible, but it will be very difficult. For the time being, letting the ACA die on the vine is the only option.