The definition of insanity is to repeat the same mistake over and over again but expect a new outcome.
In the case of the current ACA repeal and replace drama playing out in Washington, D.C., this would seem to be an apt description of what is happening.
It is literally a circular firing squad of the White House, the Republican House leadership, the Arch-conservative Freedom Caucus, the Tuesday Group representing the Moderate bloc of House Republicans, and whirling dervish of special interest groups continually shooting at each other but somehow expecting to hit a new target. We are about to reach the first 100 days of the Trump Presidency, and the way this is currently playing out it looks very unlikely that this campaign promise will be achieved.
This was among the top campaign promises we heard during the election. We were told it would be easy to repeal Obamacare on day one, and then replace it with better and less expensive coverage for all Americans. On top of that, we were also told that no cuts would come to Medicare or Medicaid. Once we saw the replacement proposal of the American Health Care Act, it appeared that maybe the exact opposite was true. Coverage for everyone is not the same thing as access for everyone. The replacement measure proposed major changes to Medicare and Medicaid, and in fact it became clear the proposal was a Trojan Horse for the kinds of changes to the program Conservatives have wanted for many years. But a funny thing happened on the way to the Forum….
The proposed replacement bill ended up dividing the Republican Party instead of uniting it. The bill was less about realistic changes or improvements to America’s healthcare system, and more about being a Conservative manifesto. It brought together many of the driving ideological factors of the Conservative movement into a legislative document that would profoundly impact all Americans in very tangible ways. It is always interesting to see ideology often abandoned for the sake of practicality. People will agree that Medicare and Medicaid should be reformed to remove waste and fraud, and to shore these program up before they go broke. But when it comes time to make the actual reforms and cuts people go ballistic and don’t let it happen. Everyone knows more needs to be done to incentivize people to take more control and responsibility for their care and the costs—but where are the actual incentives to offset the cuts? It can’t be all stick, you need some carrots to get people (and politicians) to bite!
So as the Healthcare Hunger Games continues to play out over the first 100 days of the Trump Presidency, this circular firing squad needs to start taking aim at something other than themselves. If the Republican caucuses keep arguing and moving in opposite directions; if the White House keeps taking pot shots on Twitter but never getting their arms around the substance of these issues; if special interests keep whirling around in a cloud of uncertainty; and if the American people keep screaming louder and more forcefully that by comparison the ACA is a pretty darn good program, there will be no repeal and replace.
In fact, the fallout from this abortive exercise (so far) threatens to derail any meaningful reform initiatives across the board. At this point confidence in tax reform, infrastructure, and even building that wall is extremely shaken. Members of the House and Senate know this next election cycle will be a bruising one, and with historically low approval ratings for the White House in the first 100 days, and for Republicans in Congress they are already thinking more about their own survival than major legislative initiatives. The way protests and town hall meetings across the country are playing out, it is starting to look the game they will be playing is the Election Hunger Games.
Chris Orestis is the CEO of Life Care Funding and a 20-year veteran of both the insurance and long-term care industries. His blog on senior living issues can be found at www.lifecarefunding.com. He can be reached at firstname.lastname@example.org.
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