Senator Rand Paul (R. Ky.) recently shook up Senate Republicans when he came out against the Graham-Cassidy bill, the latest (and possibly last) attempt to repeal and replace the Affordable Care Act.
While there is no doubt Paul’s opposition is sincere in his mission of thwarting the growth of government, his judgment on this matter has missed the mark.
Paul made clear his reasons for dissent in a recent interview, yet he has overlooked the aspects of pragmatism, restraint, decentralization, and federalism the Graham-Cassidy Bill encapsulates.
The bill would reduce expenditures on Medicaid and insurance exchange subsidies by $904 billion.
This goes further than the Better Care Reconciliation Act otherwise known as the “skinny repeal” that Paul himself voted for this summer. Yet the spending reduction is not the only reform of significance, the other is structural and just as vital to creating a better healthcare system.
That structural change consists of taking the remaining funds that would have gone to federal Medicaid expansion and federal subsidies for state exchanges and reorganized them into a single fund that would be redistributed via block grants to the 50 state governments.
This would allow the states to craft healthcare systems and policies that are most conducive to their own individual circumstances. This is a major shift in philosophy from the top down approach of the Affordable Care Act to a bottom up approach that seeks to turn back the tide on Washington’s growing stranglehold on healthcare.
The Senator’s (along with many libertarians) opposition to the bill stems from it not being radical enough in its free market reforms, or even the fact that there is a replacement at all bundled with the repeal. While the frustration is understandable. it is shortsighted.
Full expulsion of the government from healthcare policy is neither practical nor effective in the current system that has so long seen the private sector and government working in cooperation. Full expulsion would lead to major turmoil and a crash of the healthcare industry which would likely lead to a populist-left victory in near-future elections that would cause the implementation of a Sanders style “Medicaid for all” system.
The healthcare options of the modern world will always consists of some degree of government involvement.
The choice remaining to us today is, do we want a system of less government intervention that champions competition, market based reforms, and decentralization? Or shall we muddle on with the ACA and wait for the future date when we see the full implementation of a budget busting, federally supervised, single-payer system?
The choice should be clear for conservatives, libertarians, classical liberals, and most of all Senator Paul.
Let us hope he reconsiders before it is to late.
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