On Kennedy yesterday, Judge Andrew Napolitano explained how the GOP's "repeal" of Obamacare does nothing to touch the four foundations of the Obamacare plan.
The new plan "assumes the premise of Obamacare," Napolitano noted, explaining that the ideological and legal foundations of Obamacare are still in place.
There are 4 premises of Obamacare. The first is that somehow the federal government can regulate the delivery of healthcare. The second is that somehow the federal government is obliged to provide for health care.The third is the federal government can order you to purchase insurance for health care. The fourth is that all physicians must keep all of their records digitally ... and allow direct access to them by bureaucrats in the Department of Health and Human Services.
Did the Republican legislation that the President and his colleagues and friends celebrated on Friday of last week change any of those things? It reinforced them! And they're still the essence of the law.
Moreover, Napolitano explained, Trumpcare is likely to be a disaster politically since it does nothing to reduce costs. The Judge questioned how the new Trump version of Obamacare is an improvement, and compared the two health systems:
[Under Obamacare], if you work 40 hours per week and you work for someone with 50 or more employees, that employer has to provide health care. Under the new system you have to provide healthcare for yourself. Under Obamacare, if you don't have healthcare because your employer doesn't provide it or you're in the category where your employer doesn't have to provide it, you get charged for it by the IRS and they buy the policy for you. Under the Ryan proposal, if you don't have health care, once you do get it, your insurance carrier can bill you 3,000 dollars a year over and above your premiums for each year you didn't have it.
And yet, virtually the entire regulatory infrastructure remains in place, meaning costs can only be expected to go up.
Will this help Republicans politically? Probably not:
I think Mrs. Pelosi has a point when she says that Republicans are stuck with this and this is going to cause them a lot of harm politically. It doesn't serve those of us who believe in small government and the federal government should have nothing to do with health care, and it doesn't serve their blue collar middle class constituency that wants cheaper health care.
The federal government can't produce cheaper healthcare unless it takes money from somebody and gives it to those to subsidize the acquisition of health care.
So what should have been done?
At the very least, Napolitano notes, Americans should be allowed real choice, and not the one size fits all plan imposed on 320 million people:
If the federal government allowed the states to regulate. If you like the regulation in Texas, you can go to Texas. If you like the regulation in New Jersey, you can go to New Jersey. As Ronald Reagan used to say, you can vote with your feet.
But a first step should always be freeing up the markets in the interest of cost reduction. Congressman Thomas Massie, who has repeatedly opposed the Trumpcare legislation summed up several changes that might have actually done something to reduce costs:
This bill should have included measures that allow Americans to take charge of their own healthcare and get the government out of the way. These measures include allowing the deduction of health insurance costs from income taxes, giving everyone the ability to purchase insurance across state lines, and allowing individuals to band together through any organization to purchase insurance.
While campaigning, Donald Trump expressed support for many of these ideas, but, not surprisingly, the bill that "repealed" Obamacare had virtually no focus on cost reduction and free trade at all. It was largely a reshuffling of the deck to benefit insurance companies and other large interest groups in new ways.