Why Repeal and Replace Is Not Likely

Republicans currently face the near impossible task of repealing Obamacare and passing a replacement bill that will not cost them politically. At their core, Republicans are loathe to add additional entitlement spending to an already broken federal budget, but no political alternative exists because, since its passage in March of 2010, Obamacare has become the nation’s newest entitlement.

An entitlement in political parlance is considered as a legal right. But in constitutional terms, the foundational framework on which our nation’s laws are based, rights refer to such things as writ of habeas corpus, jury trials, freedom of religion, speech, the press, assembly and petition.

The amendments add things like bearing arms, no quartering of troops in homes, no unreasonable search and seizure, no double jeopardy, no racial or sex bars to voting and so on. In short, constitutional rights protect individuals without necessarily infringing on or imposing on the rights or incomes of others. Entitlements do.

Entitlements like Social Security, Medicare and Medicaid, and now Obamacare, are paid for by taxes and insurance premiums that are borne by some for the provision of others, raising legitimate questions of fairness on one hand, and philosophical direction on the other – will we thrive going forward as free-marketers or socialists?

Regardless of where you stand as a payer of receiver of entitlements, capitalist or socialist, Republican or Democrat, the inescapable truth is that this country’s spending and growing debt, largely due to entitlement spending, is fast becoming unsustainable. One day our debts will rule our destiny they did for Iceland and Greece. Italy, Portugal, and Spain are not far behind.

A full 70% of our annual federal budget is devoted to mandatory spending, on entitlements. The US Constitution requires our government to defend against foreign and domestic threats and to promote the welfare of the American people. The budget for doing that is only 30% (roughly 10% for defense, 10% for social programs, and 10% for other things like parks and roads etc.) Entitlement spending currently stands at 13.2% of Gross Domestic Product and is growing both as the numbers of those benefiting from entitlements grows and as more entitlements are added.

A recent poll indicated that 70% of Americans want some version of Obamacare to remain. This overwhelming majority shows just how fast and how deeply entitlements can become entrenched.

So in the end, Republicans have no political way of repealing Obamacare and replacing it with something that will not offend some large swath of Americans – whether those who are dependent on the entitlements or those who pay for them.

It seems President Obama and Democrats have largely won the healthcare debate in the sense that it has become well-entrenched as a ‘right’ among a vast majority of Americans. The best Republicans can hope to do at this point is to work toward making it as efficient as possible by carving out traditional insurance elements for private insurers, moving as much Medicaid funding as possible to the states, and setting up the government to subsidize pre-existing and costly elder care expenses the insurers will not touch.

I’ve spent a great deal of my time these past eight months working with a dedicated group of individuals to establish a faith-based primary care safety-net health clinic in Raleigh known as NeighborHealth dedicated to serving the poor and uninsured. In addition to providing holistic and continuous care, we will dramatically increase healthcare efficiencies by seeing patients that otherwise go to emergency rooms for their care ($25-$150 vs. $800), improving their overall health through education, and heading off conditions that easily become chronic if not caught and treated early. We are in touch with existing clinics throughout the country for guidance and support and hope one day to become a model for new clinics in North Carolina and beyond.

The efforts of clinics like ours and other promising healthcare initiative in partnership with state and federal governments ideally can help bring medical costs under control. If we as a country have decided that healthcare is an entitlement, then we better figure out how to get its costs under control, or face consequences not unlike Greece at worst or a permanently stagnant economy like Europe at best.