Saturday, January 14, 2017

Coalition-building, policy tradeoffs and replacing Obamacare

One of the things I pointed out in yesterday's post summarizing Republicans' options on Obamacare is that the GOP is kind of backed into a corner if there are more than two Republican Senators who won't repeal without a replacement.  The big challenge for them has always been to coalesce around a replacement-- something that they have never managed to do.  Criticizing legislation is easy.  Legislating is hard.  Why?  Real world policy choices always involve tradeoffs, and in any group of people, not everyone sees the tradeoffs the same way.

Today, let's talk about policy tradeoffs

Markets aren't magic.  If you are poor, sick or both, the free market won't give you healthcare.  Period.  Why not?  It ain't profitable.  Either the government has to put a gun to the healthcare provider's head and force them to give you treatment, or they have to put a gun to a rich person's head, take that person's money and use that money to pay the provider.  Everything else is window dressing.  Are you OK with letting poor and sick people die because you don't want to put guns to peoples' heads?  Congratulations!  You are an anti-redistributionist!  Cut those government subsidies!  But that is a tradeoff.  Don't delude yourself otherwise.  People will die when they didn't have to because you got squeamish, you thing-that-Trump-grabs, you!

Are you OK with putting a gun to someone's head to get the money to save a life?  Don't delude yourself about what's going on just because you don't see the gun.  That is exactly what redistributionist policies are, you damned, fucking hippie who probably hates guns!  (You know the title of the blog, right?).

So there you have it.  Basic tradeoff.  Stick a gun to rich people's heads and save poor peoples' lives.  That's what you are doing when you tax rich people to redistribute the money to poor people for, say, healthcare.  Don't stick those guns to rich peoples' heads and let the poor people die.

And that's before we get into the macroeconomic effects of government policy!

How much money do you take?  How much healthcare do you provide?  Lots 'o' tradeoffs.

And not everybody in the GOP draws the line in the same place.  Now, that said, the GOP Senate caucus is a lot more homogeneous than some past legislative caucuses.  Susan Collins and Lisa Murkowski are the real outliers.  On our -1 to +1 "DW-NOMINATE" scale, Collins is at 0.0370, and Murkowski is at 0.1070.  Republican median in the 113th Senate?  0.576.  With 52 Republican Senators, the GOP can lose those two by making the benefits of the Obamacare replacement much more stingy, and they are down to 50.  Pence casts the tie-breaking vote in the Senate, and the budget reconciliation bill passes.  As long as they lose nobody else.  For any other reason.  Oh, and if they have to worry about one more person pealing off, then the GOP has to get Collins and Murkowski back, which means making the "replace" more generous, which risks alienating the hardliners...

And you know I've got more to write on this general topic, right?

Coalition-building is hard, and if repealing is contingent on replacing, a repeal really might not happen.  Right now, nothing is off the table.

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