The Jury Talks Back


Rand Paul, ObamaCare, and the “Don’t Let the Perfect Be the Enemy of the Good” Argument

Filed under: Uncategorized — Patterico @ 10:38 am

It has become accepted wisdom in Washington that the most we can do about ObamaCare is tinker with it around the edges. Make marginal improvements. Don’t let the perfect become the enemy of the good, we are told.

One man, and one man alone, has consistently made a strong and public case insisting that Republicans keep their promise to repeal ObamaCare. That man is Rand Paul.

I think he deserves some praise and support, for being (as far as I can tell) the only Republican vocally demanding that the GOP do what it promised to do.

Once, Ted Cruz had a plan for dealing with ObamaCare. I talked about it in detail in this post from March. But today I want to concentrate on the first point he made:

First, begin with the 2015 repeal language. . . . Virtually every Republican in Congress voted for that language, and the parliamentarian has already ruled it as permissible. We should begin with that previously approved repeal language as the baseline.

Today, Cruz has given up on that goal. Mike Lee, whom I respect deeply, has given up on that goal. They are apparently willing to retain the ObamaCare subsidies that are doomed to drive up premiums, just as any government subsidy drives up costs (hey, has anyone noticed that higher education is a tad expensive these days?). They are apparently willing to retain most of the basic structure of ObamaCare, as long as insurance companies can offer non-ObamaCare compliant plans in addition to ObamaCare-compliant ones.

We know this isn’t their ideal solution. Cruz’s ideal solution is what I described in the March post linked above. But it is what they are settling for.

And that’s too bad. Do I blame Cruz and Lee? Only a little. There’s plenty of blame to go around — from a dishonest news media that pretends that even Cruz’s proposal is draconian, to an electorate that increasingly wants goodies without responsibility, to an education system that fails to teach basic economic principles, to a President who loves him some big government and decries even the most lily-livered tinkering as “mean.”

But I’ll be damned if I am going to be lectured by people who tell me we have to settle because hey, at least this bill is better. It’s a surrender. Don’t talk to me about Medicaid cuts. They aren’t happening. Cuts to government programs in the out-years are always phony. Always always always. The whole edifice has to be dismantled. (The details of that dismantlement are described in detail in my March post.)

I can already hear people saying: but you can’t do this to people. I commend my entire March post to you, but let me quote a couple of paragraphs for the non-clickers. The “too long, didn’t read” answer is that economics is about allocating scarce resources, and most resources are scarce:

What about the people who can’t afford insurance (or who are simply irresponsible and do not buy insurance)? Well, first of all, with the above reforms, there would be far fewer people in that situation than there were in 2008, before ObamaCare was passed. But in the end, this is a separate question from the basic policy of how to repeal ObamaCare. There will always be the less fortunate in society who can’t afford some of the basics of life: housing, food, health care, and the like. And there will always be people who are irresponsible and don’t plan for their future, whether it’s in the area of health insurance, life insurance, retirement, their kids’ education . . . the list goes on.

For these groups of people, there will always be a tension between people like me, who recommend that such issues be taken care of by charity and the private sector when the problems to be addressed are serious or life-threatening, and leftists who want the government to take care of everybody. Either way, the reality of the world is that resources are scarce, and not every need can be met. This will always be true under any system. Government cannot simply decree that everyone will receive the best possible care for every illness. Any system, whether public or private, will result in some people not being able to access scarce resources. No government health care system is a panacea, and anyone who keeps their eyes open and watches for stories of people being mistreated under socialized health care will find them. The VA is just the tip of the iceberg.

But the solution is not to give ideal care to people who could have bought insurance but chose not to. Imagine doing that with any other type of insurance: Gallant buys a fire insurance policy and Goofus does not — but Goofus knows that government will buy him a new house if his house burns down. Goofus is not going to buy insurance in that scenario — and Gallant won’t either. The concept of insurance is destroyed by such an arrangement. Some Goofuses are going to suffer in the free market — but again, no resources in this world are unlimited, and Goofus will never have all his needs met without contributing to society.

Rand Paul’s position, and my position, are lonely positions to hold. There’s this thing called electoral reality, we are told, that should prevent us from advocating we think actually ought to happen, and should force us to settle for tiny chimerical improvements.

That’s not how real change happens. It’s the kind of thing, frankly, that ObamaCare proponents were told. You can’t remake health care. People have tried. It’s too big a task. But they actually cared about ObamaCare.

The GOP once claimed to care about repealing ObamaCare. Again, just about every Republican in Congress voted to repeal it. Yet they are not being asked, again and again, why they aren’t simply implementing what they claimed to want to implement in 2015.

Don’t let the perfect become the enemy of the good? No, I’d characterize the GOP’s proposal in a different way. Like this: Don’t let the perfect be the enemy of the chance to take joint responsibility for a socialistic program that will ruin 1/6 of the economy. Or this: Don’t let the perfect be the enemy of the concession that this tiny meaningless improvement to the status quo is the best we’ll ever do.

[Cross-posted at RedState.]


  1. Once the House passed their abomination this course had been set, and neither Paul nor Cruz nor Lee could do anything about it given the White House’s apathy and lack of leadership on this issue. Cruz and Lee at least set out to craft a poison pill amendment and aren’t turning their back on their colleagues to garner press (a lesson I think both have learned in the recent years). I’m not happy with this bill at all, and support a complete failure when it comes up for a vote, but crying about this now is like suddenly getting upset that your team is now down 5 TDs in the fourth quarter when they could have done something about it in the first half.

    Comment by Sean — 7/16/2017 @ 8:03 pm

  2. Furthermore, I think it’s more than acceptable to place the blame of this bill squarely at the feet of Trump. If he had made a firm statement that he would only sign a complete repeal it wouldn’t have given cover to Ryan and the House.

    Comment by Sean — 7/16/2017 @ 8:05 pm

  3. Great post!

    I don’t like the new bill because it retains far too much of Obamacare, and further it includes a massive bailout for the insurance industry.

    What I don’t understand is why the Republicans are so hell-bent on the one-huge-bill approach. There’s not actual reason for that, and plenty of reasons not to do it. (The one-enormous-bill was, quite rightly, one of the top Republican criticisms of how Obamacare was passed).

    To give an example, why does buying insurance across state lines (which they promise for “phase II”) have to wait? Why not do that now as a stand-alone bill?

    Comment by Arizona CJ — 7/17/2017 @ 10:55 am

  4. Arizona CJ – unless they’re willing to abolish the filibuster, they’re constrained by the rules that allow them to pass the bill with fewer than sixty votes, and they have to go through the procedural rigamarole required by those rules.

    Comment by aphrael — 7/17/2017 @ 1:18 pm

  5. aphrael, true, but it might be useful to put the Democrats on the spot by making them go on record via filibustering the right to buy insurance across state lines. That’s an issue with very broad support, and no sound arguments against.

    Comment by Arizona CJ — 7/17/2017 @ 9:12 pm

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