Republican health reform: First, do no harm

"First do no harm," a maxim often attributed to the Hippocratic Oath, is the advice from former House speaker Newt Gingrich to Senate Republicans as they work toward their stated goal of passing a health reform bill before the July 4 recess.

In a significant editorial piece at, Gingrich is urging Republican senators to "slow down" and take a more "measured" approach to repealing and replacing Obamacare:

In 2009, when President Obama proposed his healthcare bill, Republicans warned it was the first step toward a single payer system. Eight years later, if Washington Republicans do not change course soon, they will make that prediction reality.

Washington Republicans are operating under the faulty assumptions that they must pass a healthcare bill quickly to "move on" with the rest of their agenda and that the collapsing individual health insurance marketplace is giving them the momentum and mandate they need to do so. Two recent events should cause them to reconsider.

Gingrich cites the recent election in Great Britain, in which Theresa May lost her majority and hurt the momentum toward a successful "Brexit."  According to Gingrich, "May's Tories made the mistake of proposing changes" in taxes that affect the elderly.  While the changes may have been practical, the opposing party "successfully branded the change a 'dementia tax,'" and May's party paid the political price at the polls.

Gingrich contends that several problems in the House-passed health care legislation make the bill "politically toxic," citing an age-based premium structure that exposes the bill to Democrat branding:

Republicans need only to look overseas to see how the public would respond to an "age tax" branding.

Thanks to Democrat messaging and Republican fumbling, the Democrats have already succeeded in branding the Republican bill as hostile to patients with pre-existing conditions.  As Rich Lowry at points out, "[s]uch is the hysteria around this issue that using the phrase 'pre-existing condition' has become a license for making any charge whatsoever."

Speaker Gingrich cautions Republicans to heed the lesson from Britain's election and carefully "think through" all of the consequences of any health care changes included in their reform bill.

Otherwise, they are likely to fail to pass healthcare reform – or worse, they might pass a bill that is unacceptable to the American people. Either result would bring huge Republican losses in 2018 and further entrench ObamaCare.

The second event Gingrich references is the passage by the Nevada legislature of a bill that would open the state's Medicaid program for anyone to enroll, expanding Medicaid to essentially become "a single-payer government option for all Nevada residents."

Nevada's Republican governor, Brian Sandoval, vetoed the bill last Friday, saying "there were too many unanswered questions about how the program would work" and that the bill is "an undeveloped remedy to an undefined problem."  But the fact that such a bill reached the governor's desk is a sign of the opening that Obamacare's instability gives Democrats to push single-payer programs on lawmakers who are under pressure to solve the Obamacare crisis.

As Gingrich observes, the "failing marketplace" of Obamacare has put Nevada's governor in a bind:

The situation in Nevada shows that chaos and instability in healthcare does not help the Republican case for free market reform – it undermines it.

With the Obamacare status quo being clearly untenable, the Democratic Party's drive toward single-payer health care is becoming a formidable force that the Republicans can ill afford to allow any further traction:

  • The Los Angeles Times reports that "California Atty. Gen. Xavier Becerra said Tuesday that he supports a proposal for California to adopt a single-payer health plan and believes it will eventually be enacted because consumers will become 'fed up' with the current system that he said is unaffordable to many."
  • The New York Times says, "Democrats and activist leaders seeking political redemption have embraced an unlikely-seeming cause: an actual government takeover of health care," and that "leaders say the party has plainly shifted well to the left on the issue, setting the stage for a larger battle over the health care system in next year's congressional elections and the 2020 presidential race." 
  • The New York Times also notes that "[i]n the House, 112 of the 193 Democrats have co-sponsored a single-payer bill proposed by Representative John Conyers Jr. of Michigan and called the 'Expanded and Improved Medicare for All Act.' Until recently, the bill had attracted a fraction of that support."
  • Bernie Sanders, arguably the most popular Democrat politician in America, has posted a manifesto of sorts, suggesting that Democrats too can learn a lesson from the recent British election.  Sanders contends that, regarding that election, "there is widespread agreement that momentum shifted to Labour after it released a very progressive manifesto that generated much enthusiasm among young people and workers." 

Sanders goes on to say that "too many in our party cling to an overly cautious, centrist ideology" and further declares that "Democrats must guarantee health care to all as a right, through a Medicare-for-all, single-payer program."

Gingrich contends that Republicans need to create some "breathing room" by solving the "immediate crisis" in health insurance markets.  In Gingrich's view, that would include taking steps to "stabilize" markets, such as funding insurer subsidies and pre-existing conditions while moving more deliberately on a "fuller health reform package."

President Trump conveyed a similar message to Senate Republicans in a meeting last week, calling the House-passed health reform bill "mean" and suggesting that we need a bill that is "more generous, more kind," and "more workable for the American people," according to senators present at the meeting.

With congressional Republicans remaining severely divided about changes to the House repeal and replace bill, the Republicans would be wise to heed Speaker Gingrich's advice, proceeding cautiously in the few days remaining before the July recess, while doing no harm.

Whether "the disaster known as 'Obamacare'" ultimately serves as an inoculation against more government-run health care or as a prelude to single-payer Medicaid/Medicare for all remains to be seen.

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