Republican Senators have clearly demonstrated that, without the correct principles, there is no basis for health care policy. A tiny majority in the Senate were unable to overcome the giant chasm that separates American principles–rooted in individualism and freedom–from whatever we have now.
In these circumstances, a shallow parliamentary device to overcome the requirement of 60 votes to pass legislation was doomed. Considering the number of Republican senators who vigorously defended the huge expansion of Medicaid under Obamacare, the device was also ridiculous.
Republicans failed to repeal Obamacare because they did not want to.
Despite having just elected a new Congress, there is now no prospect for repeal of Obamacare until we elect another one.
The first task is to clearly promote the correct foundations for policy. As discouraging as the prospects for legislative relief are, at the moment, we must not shut up. We must talk, and write, and annoy members of Congress with the right ideas. And next year, we must vote.
There is an immediate role for some tactical steps, including the elimination of regulations imposed during the Obama administration. We should cheer new Secretary of Health and Human Services, Tom Price, as he destroys what President Obama imposed by whim with his “phone and pen.”
Whatever we think of President Trump, President Obama did not sit around waiting for majority support from the U.S. House or Senate. We must expect the Trump administration to clean up the current mess, and the courts to clean up the unconstitutional bits. We must expect the Justice Department to continue to go after constitutional issues in court.
At least one bright spot: a major channel of reform opened up at the Food and Drug Administration. The newly-appointed FDA chairman, Dr. Scott Gottlieb, is taking on that huge, 110 year-old bureaucracy. Streamlining and shortening the lengthy approval process for new drugs and medical procedures has been an early priority. This will lower the cost of new drugs and save lives–not least, the lives of terminally ill patients dying while waiting for drugs to be approved.
After many years of the FDA defending its approval gauntlet for new drugs, some pharmaceutical and medical equipment manufacturers have long since knuckled under to the political games. They have transformed from victims to enthusiastic partners in a political spoils system.
One way that Dr. Gottlieb has taken action to break up the party is by eliminating obstacles to competition in the manufacture of generic drugs. More inexpensive generic drugs will allow forward leaps in affordable medication.
At the other end of the spectrum, a free environment for new genetic therapies and personalized medicine can improve, or even revolutionize, care. If we can keep the FDA out of the way.
We can speculate about the precise way that aspects of Obamacare will fall apart. The prospect for the insurance exchanges seems particularly death spiral- like. Whatever form failure and collapse take, we can look forward to many proposals to save current regulations or make them worse. We must strive for the eloquence of principles, including individual choice and free markets, to make sure that proposed legislation goes nowhere.
Richard E. Ralston
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