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On health care, Republicans may regret opening this door

Updated

Sen. John Kennedy, a Republican freshman from Louisiana, said yesterday that he likes the idea of turning health care over to the states – the core rationale behind the pending Graham-Cassidy proposal – but he’s not entirely comfortable with the direction some blue states might take,

“If you give California and New York a big chunk of money, they’re gonna set up a single-payer system,” the GOP senator said. “And I wanna prevent that.”

It’s curious. Republicans only seem to like turning over authority to states and local governments when they’re confident states and local governments will govern in a conservative way.

But in this case, Kennedy’s concerns probably aren’t quite broad enough.

Whether congressional Republicans recognize this or not, they’re in the process of creating a new governing standard. GOP leaders are telling everyone – the public, the health care industry, even the future – that Congress can radically overhaul the nation’s health care system, ignoring the wishes of the public and stakeholders throughout the industry, without any real debate, scrutiny, or even a full Congressional Budget Office analysis. According to Republicans, this is an entirely legitimate exercise and an appropriate use of legislative power.

The funny thing about legislative power, though, is that eventually it changes hands.

When various observers make the “imagine if Democrats did this” argument, they’re usually making a point about double standards and partisan asymmetry, but in this case, it’s a little different. When it comes to health care, “imagine if Democrats did this” becomes a point about deteriorating norms.

What Republicans are doing is essentially lowering the bar. If you want to radically change one-sixth of the world’s largest economy, affecting the health security of millions of Americans, GOP leaders are now saying you don’t hold committee hearings or listen to subject-matter experts. You don’t need scrutiny or any meaningful sense of consequences. All you really need is a majority and a partisan goal.

But once that door is open – once the governing norms of the United States are shattered – there’s no reason Democrats won’t take advantage of the opportunity.

New York’s Jon Chait explained this morning what would happen if the current GOP gambit succeeds:

It would make it easier for the left to argue that the [ACA’s] compromise structure is a failure, that its markets are inherently susceptible to sabotage by Republican administrations, and that the risk of political capital is worthwhile. And the method used to pass repeal – a hastily assembled reconciliation bill devoid of serious analysis – would make fools of the party’s Senate institutionalists. Democrats would be incentivized to pass a sweeping 50-vote Medicare expansion, with the goal of creating as many beneficiaries as possible, as quickly as possible.

Heightening the contradictions of the system is a longtime tactic of radicals on the left. How strange to see this very dialectic embraced by the far right.

John Kennedy is worried about Democrats in blue states pursuing single-payer? What he should be worried about is Democrats in Congress taking a page from the Republican playbook and passing single-payer in 2021 with 50 votes and no CBO score.

Health Care

On health care, Republicans may regret opening this door

Updated