Sens. Bernie Sanders (I-Vt.) and Ted Cruz (R-Tex.) debated healthcare reform at a 90-minute CNN town hall, with Sanders insisting healthcare was a right and Cruz saying instead that "access to healthcare is a right."
Cruz said on the presidential campaign trail he urged Congress to "repeal every word of Obamacare," but that that did not mean they were "done yet with healthcare reform." He repeated the primary components of an Obamacare repeal bill he's submitted, which does not actually repeal the entirety of Obamacare but does eliminate the mandate and permit the sale of state insurance across state lines, long-time Republican proposals.
But over the last seven years, while they voted dozens of times to repeal Obamacare, Republicans did little work on the "replace" part of their "repeal and replace" mantra since they didn't control the White House. But, as Peter Suderman wrote last week, Republicans have now found themselves without much of an idea on a unified way forward.
Sanders' debate performance, meanwhile, was a reminder of some of the dangers of populist rhetoric on policy making. Sanders insisted healthcare ought to be a right for all Americans. When Cruz pointed to rationing, waiting times, and lower quality service in countries with such arrangement, Sanders claimed that healthcare pricing was a form of rationing of its own. Insofar as government intervention distorts pricing incentives, he's right. Decades of government regulation, intervention and favoritism in the insurance and healthcare industries have largely divorced prices from any market forces, which can "control" prices better than any bureaucrat.
Sanders illustrated this himself, trying to answer a question from a woman who said she ran a hairdressing salon business and could not hire more than 49 employees because she could not afford to offer healthcare benefits to her employees. Sanders pressed her on specifics, pointing to hypothetical competitors against whom she would have an "unfair" advantage for not offering healthcare. At one point, Sanders said he "didn't know about" the hairdressing business. But that's precisely the problem—government bureaucrats don't know anything about business, and efforts to intervene inevitably have unintended consequences that most often drive prices up and quality down.
President Trump—who signed an executive order suspending all fees and penalties associated with the Affordable Care Act has said all kinds of things about Obamacare and healthcare reform that could be interpreted in any way—was barely mentioned in the debate. Trump's travel ban executive order wasn't mentioned at all, even when Cruz pointed out that healthcare services in the United States were so superior that people came from the world over. The executive order swept up people from banned countries who had made previous arrangements with healthcare providers in the United States for specific services, arrangements that aren't as easy to make, and may not always be possible, in other countries. A Canadian provincial official offered to help children frozen out of their procedures in the U.S. to come to Canada—normally Canadian immigration officials can, and do, deny entry to immigrants whose illnesses are deemed a threat to public health, or could cause "excessive demand on health or social services." Such fears fuel anti-immigrant sentiment, and the larger the guarantees politicians like Sanders can actually secure, the easier the sentiment becomes to fuel. A government of handouts isn't sustainable, with or without immigration.
Normally, a Republican president would not accept the premise that healthcare was a right—that's far from certain in this case. And even when Republican presidents do, it doesn't prevent government healthcare expansions like President Bush's Medicare Part D. Republicans have offered a number of different Obamacare-related plans, but the White House has not yet set a pace. Given how little pushback the vast majority of Republican members of Congress are giving the Trump administration so far on historically unorthodox policy positions (Trump could not promise in his Super Bowl interview that Americans would get tax relief this calendar year—an easy promise for a Republican president with a Republican Congress to make), the possibilities for what could happen next with healthcare are endless. As may be Obamacare.
If you missed it last night, you can watch the whole debate, and wonder what might have been in 2016, below: