Opportunity in the Middle

In Monday’s post, we began to contemplate the consequences of the defeat of the Republican healthcare bill through the lens of the laws of motion: inertia, acceleration, force and mass, and actions producing equal and opposite reactions.

Well, the equal and opposite reaction thing seems fitting given the chatter of the past couple of days.

Most of the reaction has centered on the Freedom Caucus, the very conservative faction of the Republican party that killed the bill.  Their supporters hail them as conquering heroes who just dropped their trousers and mooned the establishment, something they all would individually do if they could only get a permit for the Million Moon March on the DC Mall.  The most vociferous opponents of the Caucus have made not-so-subtle intimations that their parents met at a family reunion.

Ironically, by rejecting the plan because it did not go far enough in repealing ObamaCare, the Caucus increased the odds that the solution – if there ever is one – will be more liberal than the Price-Ryan plan. 

Today, ObamaCare continues; Medicaid expansion – the fastest growing government entitlement program and a chief contributor to the rising federal deficit – continues unabated; the exchange market under the ACA will continue to struggle, and while that might seem to be a good thing to certain Caucus members, it sets the stage for liberals to resurrect the argument that the answer is the public option or even a single-payer system – they will find more frustrated citizens willing to listen to the case.

Equal and opposite reactions.  Dang, Newton was smart.

Thus, we return to a thought we had last summer when it was presumed by everyone that we’d now be trying to figure out what to call that guy standing next to President Clinton (the First Dude?).  The imagined scenario was that Mrs. Clinton, facing the reality of ObamaCare failing under its own weight, would sit down with Speaker Ryan and negotiate some compromises.  Compromises are always found in the middle.

Is that where the answer is to be found now?  That is hard to imagine in today’s Washington, and the Democrats reaction to the Republican embarrassment of last week does not suggest a team open to sitting down together over a beer to hammer out a solution.  Kick ‘em while they are down.

But, the President says he might have to make a deal with the Democrats.  Remember, he is a deal guy, not an ideologue.  And Paul Ryan, while solidly conservative, is a policy wonk who knows the numbers better than anyone.  He knows that eventually, we have to do something.

Look, nothing on either end – what the Freedom Caucus would champion or anything that comes up on Google when you enter ‘Bernie Sander’s + healthcare’ – is going to get through the process.  The answer is somewhere in the middle.


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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