In one way, the fight to replace ObamaCare seems to be entering a final phase: ObamaCare is collapsing of its own weight before our very eyes, possibly more rapidly and conclusively than even its harshest critics anticipated.
In another way, however, the battle can be seen as likely entering into a new and even tougher phase to replace ObamaCare with a patient-centered, free-market reform if Hillary Clinton, who has her own history with health care, becomes president.
Former senator Phil Gramm tackles the question of where Hillary Clinton would take ObamaCare in a must-read piece in today's Wall Street Journal. Gramm points out that a single-payer, national health system has always been her aim. Her failed attempt at health care reform in 1993 provided valuable lessons when the Democrats tried and succeeded with ObamaCare:
HillaryCare was a comprehensive plan for the government to take over the health-care system, with program details and cost-control measures precisely defined. Having learned from that defeat, the Obama administration left as many details as possible to be written during implementation after ObamaCare became law. With few details to defend and the clear falsehood that “if you like your health-care plan you can keep it,” President Obama pushed through his “signature” legislation.
Gramm asserts that ObamaCare was always going to be an interim achievement:
While Bill Clinton recently denounced the Affordable Care Act’s effect on the health-care market as “the craziest thing in the world,” ObamaCare was never anything more than a politically achievable steppingstone. As with HillaryCare, a single payer, national health-care system has always been the goal.
Gramm, Senator John McCain, and the late Senator Paul Coverdell led that GOP fight against HillaryCare. They defeated the plan by focusing on the loss of freedom it would visit upon the American people. It was the loss of freedom, not the unaffordability, that finally turned the tide against HillaryCare. Gramm writes:
The stone that slew the HillaryCare Goliath was freedom. Even the Democrat-appointed head of the Congressional Budget Office was forced to conclude that under HillaryCare health-insurance premiums were federal revenues and all health-cooperative expenditures were federal outlays.
The decisions of HillaryCare’s National Control Board, which would have determined every allowable benefit and treatment, would have been final—not reviewable by any agency or judge. What finally broke the back of HillaryCare was the provision imposing civil penalties for providing treatments not allowed by the regional cooperative and criminal penalties for accepting a separate payment for providing such care within a cooperative.
Families were forced to pay into the regional cooperatives and medical providers had to provide all medical care through the cooperatives or operate completely outside them. Since few families could afford to pay the cooperative for health care and then pay for additional care, and few providers could afford to operate totally outside the system, any real health-care choice would have been extremely limited, very expensive and available only to the highest-income families. When challenged to defend the loss of freedom HillaryCare entailed, congressional support collapsed and no effort to resurrect it was made until ObamaCare.
. . .
ObamaCare’s plan was always to cook the frog slowly. It didn’t immediately close the individual market or shut down the small-group market as HillaryCare did. President Obama granted substantial flexibility in implementation, such as suspending penalties for individuals and employers, waiving income-verification requirements and easing the premium shock on young enrollees by administratively adjusting the community-rating system. But the result of delaying the coercion ObamaCare requires has been an explosion in health-care premiums and massive losses by insurers.
Gramm says that the withdrawal of insurers from ObamaCare is really not a problem–except that they are happening at election time. ObamaCare, the former senator asserts, was always going to eliminate the "facade of private insurance" and become more like HillaryCare.
If elected, Mrs. Clinton could well accomplish what she failed to do in 1993, Gramm argues.
ObamaCare is falling–both sides have in their grasps the real reform that is needed.