The Lord giveth and the Lord taketh away, but for governments it's not that easy. Once something is given - say, health insurance coverage to 20 million Americans - you take it away at your peril. This is true for any government benefit, but especially for health care. There's a reason not one Western democracy with some system of national health care has ever abolished it.
The genius of the left is to keep enlarging the entitlement state by creating new giveaways that are politically impossible to repeal. For 20 years,
People hated Obamacare for its highhandedness, incompetence and cost. At the same time, its crafters took great care to create new beneficiaries and new expectations - which makes repeal very complicated.
Granted, the number is highly suspect. The CBO projects 18 million covered by the Obamacare exchanges in 2018. But the number today is about 10 million. That means the CBO estimate of those losing coverage is already about 8 million too high.
Nonetheless, there will be losers. And their stories will be plastered wall to wall across the media as sure as night follows day.
For example, Ryan wants to ease the pain by phasing out
Moreover, the idea that you can eradicate Obamacare root and branch is fanciful. For all its catastrophic flaws, Obamacare changed expectations. Does any Republican propose returning to a time when you can be denied health insurance because of a pre-existing condition?
It's not just
So what do you do? Obamacare imposed a monetary fine if you didn't sign up, for which the Ryan bill substitutes another mechanism, less heavy-handed but still government-mandated.
The purists who insist upon entirely escaping the heavy hand of government are dreaming. The best you can hope for is to make it less intrusive and more rational, as in the Ryan plan's block-granting
Or instituting a more realistic age-rating system. Sixty-year-olds use six times as much health care as 20-year-olds, yet Obamacare decreed, entirely arbitrarily, that the former could be charged insurance premiums no more than three times that of the latter. The
Premiums better reflecting risk constitute a major restoration of rationality. (It's how life insurance works.) Under Obamacare, the young were unwilling to be swindled and refused to sign up. Without their support, the whole system is thus headed into a death spiral of looming insolvency.
Rationality, however, has a price. The CBO has already predicted a massive increase in premiums for 60-year-olds. That's the headline.
There is no free lunch.
Unless, of course, you go the full Machiavelli and throw it all back on the
Upside: You reap the backlash. Downside: You have to live with your conscience.
Credit: By Charles Krauthammer For the