Republicans should not be shocked if President Trump decides to dump them and work with Democrats on future projects. Now that the Paul/Cruz/Cotton/Freedom Caucus crowd has determined that RyanCare was not pure enough for them, the president might well decide that his new party is a bunch of losers and that he might do better by building a coalition among blacks and the “ordinary” folks who dragged him across the finish line in PA, Michigan, Ohio, Wisconsin, and other bluish states. Obviously, the ideological, socialist wing of the Democratic Party would never support him, just as the ideological free-market wing of the Republican Party has now disappointed him, but that leaves a big space in the middle, people who don’t give a hoot about Marx or Milton Friedman but are quite concerned about the security and prosperity of the nation.
Irony abounds. RyanCare was inspired by a free-market vision but became, under the restless pen of Speaker Ryan, a horse built by a committee, an altogether different creature. Who among us really understood Phase I, which seemed intended to buy support among moderates of either party by providing financial assistance to the needy – but ended up as an indecipherable jigsaw puzzle of progressive-style redistribution? Who believed that Phases II and III, which were deferred because they supposedly could not qualify for the filibuster-proof “reconciliation” process, would suddenly turn the pricing of healthcare and healthcare-insurance over to a competitive, deregulated, free market? Answer: very few of us. RyanCare’s heart might have been in the right place, but the plan looked more like a Soviet Five Year Plan than like something that Hayek or Milton Friedman would have liked.
Could it have been otherwise? Sure – plenty of smart conservatives have articulated elegant, simple, free-market models that could have been understood by the voters. The common theme of these proposals was that government was to get completely out of the business of controlling the healthcare insurance business and determining which treatments and procedures you are allowed to obtain, from whom, when, and at what price. Government’s one and only role in healthcare and insurance would be to provide financial assistance to people who needed it in order to pay the market price of healthcare and insurance. Medicare would merely verify eligibility and collect and disburse money. Clearly, the transition from the central-planning model (ObamaCare) to the free-market model would have taken time, effort, and money and would have involved special provisions (e.g., grandfathering) to address individual cases of hardship or unfairness, but that would have been a one-off project that would ultimately add enormous value. On the contrary, it appeared that under RyanCare, the government would jump in and manage the transition but that it would never jump back out.
Would a simple, free-market model have been approved by Congress? The guess here is that it would, as the provisions for transition and for assistance to the needy would have gotten the moderate Republicans on board, and the provisions for deregulation and free-market pricing would have warmed the hearts of Rand Paul, Tom Cotton, and the rest of the purists, and the support of both moderates and purists would have carried the House and put a lot of pressure on a lot of Democrats in the Senate, as the Trump machine flexed its new muscle and made things tough for Democrats up for re-election in red states. And if it had not worked, the blame would have lain squarely with the Democrats, which the voters would have noticed. But now we will never know. The Republicans got too cute and now both the party and the president have taken a huge blow, and only the president appears to have at least one path to recovery, a path that should infuriate Republican voters.