You do not like Obamacare.
SO you say.
Try it! Try it!
And you may.
Try it and you may I say.
Senator Ted Cruz has been at the forefront of the quest to repeal Obamacare for months now, and has specifically spent the August session break calling to de-fund the health care law Republicans have ineffectively repealed over forty times now. Things have not gone quite as he might have liked, however - the past week has seen Speaker of the House John Boehner push a continuing resolution bill through the House of Representatives that gives the Tea Party wing everything they wanted. Sequestration continues at current levels, and the continuing resolution to fund the government does so specifically while cutting all funding to Obamacare. But if the Tea Party got everything they wanted, why is Ted Cruz angry enough to say he will not like it in a house, he will not like it with a mouse?
It's important to remember that we are not presented with the Defund Obamacare bill here. While yes, we are discussing Obamacare in this continuing resolution bill, we aren't passing the legislation a second time and thus Senator Cruz's filibuster is not an impediment in the way of the passage of health care legislation. While the Republicans have voted over forty times to repeal Obamacare, not once has this procedural vote actually provided an obstacle to the health care law's implementation - we don't have to go back and pass it twice all of a sudden. Cruz's filibuster is coming at a very weird time, and timing matters... so let's look at the nitty gritty details of what this means and why now.
Senator Cruz has said that Speaker Boehner's failure in the House of Representatives has forced his hand right now into delaying tactics, and Cruz has thrown up a filibuster to prevent the bill even being effectively brought to the floor in order to stall as much time as possible at as many procedural points as possible knowing that some of them may earn the effective slowdown he needs to push the continuing resolution to the point of crisis. Since he lacks the support of his party enough to delay the continuing resolution via holds and other procedures, he has to jam it with his body by talking as long as he can as many times as he can to push the Senate's continuing resolution to fund the government up against the barriers time has set forth: funding runs out if a bill is not passed by September 30th. That means he has to get somehow from September 24th to September 30th without the Senate passing the bill, and procedural rules for timing considerations are already helping his case at least a little bit as time is given to the opposition party for consideration by the protocols of the Senate. To get the rest of the way, however, he'll have to stand there and talk even if it means reading Green Eggs and Ham to his children via C-Span.
The mistake that was made politically was made by Speaker Boehner when he passed a continuing resolution bill that reads as a wish-list for the Tea Party in the first place... and did so quickly and without Democratic Party support in the House of Representatives. Speaker Boehner wants to avoid the re-election nightmare a year from now where the House Republicans have to face the music for bringing on a government shutdown, and that's very understandable, but if funding Obamacare is a hostage worth taking, it's a hostage worth taking well. A House bill that began with defunding Obamacare and traded to a point where Obamacare was funded in the continuing resolution but other considerations have been made and voted for by the Democratic Party would go to the Senate as a bill President Obama could theoretically sign into law, and the Senate would be obligated to begin with that bill and honor the bipartisan effort in the House that brought them that painful compromise to shrink the deficit by increasing austerity measures and amplifying the budget cuts of the sequester. As it stands, with the Tea Party wish-list of a continuing resolution on the Senate floor, Senate Democrats can act from a position of strength and with a clean conscience as the only adults in the room: get enough Republican support through bipartisanship to get a continuing resolution that will pass the sixty-vote filibuster threshold and they can get everything they want while averting a government shutdown through the reconciliation process, requiring only fifty-one votes in the Senate to put their vision of a continuing resolution into law.
With a Congressional Budget Office projection officially murky, we are left with the official tally going into the law's implementation - $700 billion over ten years - as the rough budget increase that comes as a price of defunding Obamacare in the House bill. $70 billion a year is the budget increase voted for by the House of Representatives under Speaker Boehner alongside their deficit-reduction efforts under the sequester, and a Senate bill being reconciled with the House bill thus can reach the same budget numbers by funding Obamacare and restoring $70 billion in cuts put into place by the sequester. The numbers will match but the details will be different, and with fifty-one votes in the Senate, the budget crisis will pass with no government shutdown, no halt on Obamacare, and in fact an end to the sequester if the Democrats want to go there. That's what Senator Cruz is trying to jam with his body if with nothing else, because he won't be able to filibuster the reconciliation and the end-game is they lose.
Reconciliation is thought of as a "dirty trick" of Senate procedure, but is it a dirtier trick than threatening a government shutdown? Clearly not. So to save the Tea Party's principles he has to place the blame on Speaker Boehner for not selling off the Tea Party's principles at a price that was worth getting, to cave on Obamacare and get something for it... instead of cave on Obamacare and maybe still be electable in 2014 in the face of a Tea Party primary challenge. And thus we see the Tea Party's darling stand up for his principles in a fight he cannot win even by running out the clock, because the Tea Party in the House of Representatives was too blinded by ideology to govern effectively, compromising their principled stance in order to get something for a hostage they could never effectively take anyway.
The voice that was absent, however, was a Republican vision for what they would do if not Obamacare. The facts of the matter at present show that our system is currently a mess, and a firm step in any concrete direction is better than staying where we are. While costs can be cut and efficiencies improved by Obamacare's strident step towards single-payer socialized health care, according to the Tea Party's own free-market principles costs can be cut and efficiencies can be improved by meaningful free-market solutions and deregulation of laws that are barriers to effective health-care cost controls. This is the voice that has been absent while Senator Cruz read "Green Eggs and Ham," but here are some of the pillars of what that argument would look like:
* End employer-based healthcare coverage. From a free-market perspective, much of the problems we see in the current system is because losing your job changes your healthcare status, and in fact Obamacare digs us deeper into this one by disincentivizing new employees around key numbers (that 50th hire's a doozy!) and disincentivizing full-time employment (too many of the new jobs added since the Affordable Care Act was signed into law have been part-time for a reason). Pre-existing conditions cease to be a problem if you're carrying the same insurance plan your whole life, except as a free-riders problem where healthy people will try and game the system and not buy insurance until they are facing down a health emergency. You can then apply a tax basis to noncompliant individuals in order to prevent free riders by taxing them out of existence, which doctrinarian Republicans cannot say out loud without Grover Norquist giving them the stink-eye. Wages will be higher because these costs are already factored into your employment, employment will be easier (and thus recovery from downturns should occur faster), and individuals will have more freedom to shop around because they get to pick and choose, not their boss, increasing competition and thus driving down costs.
* End state-line borders in the competition for insurance providers. There's sunk costs to infrastructure and personnel that you're requiring be replicated fifty times over because something something state's rights, and it's because of a weird exception to antitrust laws passed in the 1945 McCarran-Ferguson Act which grants automatic exemption to antitrust regulations in return for insurance companies settling into the artificial limitation of state lines. Small state-based insurers won't really compete enough to lower costs by seeking efficiencies, and no insurer can build a big enough pool of risk to be well and truly effective because they are prevented from aggregating across state lines. Whether we go further forward to socialized medicine or towards free-market solutions, McCarran-Ferguson will need to be addressed in order to really fix the system instead of patch over its flaws.
* Scale back Medicare and Medicaid. There is no Medicare funding - the $2.5 trillion that is cited as its funded liabilities has all been spent, every single dime, and replaced with Treasury bills as IOU's that nonetheless will need to come out of future taxpayer dollars. If we fundamentally change the system to a more effective system, then we can also fundamentally alter the terms of this promise without altering net access to healthcare. These terms need to be changed with a step in either direction, and Paul Ryan's budget privatizing (and thus destroying) these systems needs to be more human and less spreadsheet while addressing the fact that those who live long enough to collect on Medicare receive on average $4 in benefits for every $1 they paid in. We are using this system to collectively bargain for lower healthcare costs for those who have access to Medicare, but an actual means-testing system rather than calls to outright phase it out of existence immediately would address the fact that many who are receiving these benefits are receiving them after a lifetime of earning while those being taxed to provide those benefits are young people with no wealth accumulated over the course of a long lifetime as their elders might potentially have, who would receive higher wages if they were not paying taxes into a system that at least for the near future is structurally unsound as the Baby Boomers age into retirement and Medicare costs balloon out of control. Medicaid is our inherent promise that we will take care of you, but a free-market principled proposal would fix the many other structural problems that are putting health-care costs out of reach and only then talk about scaling back these programs.
* Change bankruptcy law so that medical debt can be discharged by bankruptcy but not written out of existence when we do so, providing a government guarantee on any such debts discharged to transfer this debt to the public as a whole at a pre-set but non-trivial number. With bankruptcy law such as it is, hospitals have to charge two or three times the cost in order to clear budget shortfalls caused by nonpayment of these debts and the complications of medical debt in bankruptcy law - so long as you're alive and paying at least a dollar, the hospital doesn't get paid by you or the government or anyone else, so if only one out of three uninsured individuals pays their bills, that one person needs to pay three times as much. Medicaid would shift forms to cover this need while also being drastically scaled back as we make other massive systemic changes.
* Implementing tort reform to limit damages helps to lower malpractice insurance and price creep due to the implementation of "defensive medicine," tests ordered only to affect the doctor's potential liability. This has little to do with the actualities of medicine but instead covers the fact that Americans are the most litiginous people on Earth and you can win a million dollars when you sue if you sue for something as asinine as not knowing HOT COFFEE IS HOT.
* Repairing the bureaucracy creep that comes from our current system's incompatability with itself. Paperwork costs are a significant chunk of cost creep according to the New England Journal of Medicine, with thousands of small plans and different insurance types requiring a serious level of accountancy for hospitals just to get paid. With one universal form you fill out if you're a healthcare provider that you give to all the insurers, instead of one form each for all of the thousands of insurance provider plans, more healthcare money is spent on healthcare rather than bureaucracy, keeping costs low and healthcare affordable while also greatly improving the transparency and understandability of the system to the individual patient.
Those are the pillars of fixing the healthcare issues without moving towards socialized healthcare's single-payer system. It just happens to be that House Republicans have instead focused on de-funding Obamacare on a weekly basis, and now they are reading "Green Eggs and Ham" instead of providing their own vision of a free-market solution to Obamacare's steps towards socialized medicine while filibusterng their own party's House bill being presented onto the Senate floor. No wonder the Democrats have dropped everything and grabbed for the popcorn to watch the Tea Party implode the Republican Party right in front of their eyes. The true conservative voice speaking in advocacy of free-market principles would be hitting the points above and crafting a counter-proposal. Instead of that voice which was missing, we got the following: