The GOP's latest and probably best last chance of repealing Obamacare rests on the outcome of a vote on the Graham-Cassidy health-care bill. Again its passage hinges on a few Senators such as Sen. Lisa Murkowski, Sen. Rand Paul and Sen. Susan Collins. Sen. John McCain who was the deciding vote which killed the last GOP attempt has declared he will again vote 'no' on this bill.
The controversy surrounding rounding up enough votes for a GOP Obamacare repeal and replace bill is emblematic of how the GOP is carelessly losing the battle of ideas. The discussions of if and who may vote for this bill has vastly undermined and overshadowed the conversation that should have been happening at this stage. That is, making the case why this bill or GOP ideas may be better alternatives to the present Obamacare bill which continues to hike premiums and lower health care choice.
For years since debate and implementation of Obamacare hundreds of op-eds, conservative think tank proposals and speeches were made on not only about the negative effects of Obamacare, but also why conservative solutions could lower health care costs, allow more choice, accountability and competition, while effectively providing healthcare to the poor. Those ideas have not had a chance to earn wide public support as they should have because they have not been a galvanized effort to sufficiently communicate them to the public.
This is not due to the fault of the Graham-Cassidy bill itself which includes some of these ideas, but due to the lack of process within the GOP and conservative circles to make an argument to those who don't normally sit in their pews on why these ideas will translate to benefits over Obamacare. The party and movement had 7 years to come up with alternatives and should have united around certain core features by now. While the Trump administration has made progress in reforming the FDA to remove regulations and outdated rules which have driven up drug costs and slow innovation, this has not been communicated effectively to the public as how the GOP ideas are already working.
President Trump is right to slam some congressional members for not coming up with ideas to repeal and replace Obamacare or supporting bills to do it, but he has also wasted a lot of time earlier in his young presidency in uniting Republicans around ideas they can all support. He has also missed the unique opportunity to properly grasp detailed policy ideas and directly take them to the American public with presidential addresses like President Obama while selling Obamacare. Rallies may work better in campaigns but for consequential bills such as on healthcare the president should use the weight of an Oval office address to get certain points across. It is not just about the art of the deal, it is also about the art of the sale.
At this stage of the process, the GOP should have been vehemently overcoming objections from Democrats and skewed analysis from the CBO. They should have been winning with arguments on how certain conservative ideas such as, encouraging healthcare insurance competition across state lines, bringing accountability and efficiency to Medicare and Medicaid, block granting funds to states, and further reforming of the FDA would tackle the real drivers of increased costs and waste in healthcare and would bring about true affordable insurance. Absent this substantive debate, the vacuum is mostly filled with fear mongering from Democrats and their allies in the media and late night TV.
Some congressional Republicans and conservatives who want to be the next 'Reagan' have also tried to prove their purity on all or nothing approaches and gained nothing at the expense of incremental victories which could have led to achieving most of those principles. I think the Gipper would be disappointed on many levels on how today's Republicans and conservatives have lost the art of making gains through incremental victories and making the case why certain ideas can work to earn support. Graham- Cassidy or any other health care reform bill would vastly have given Health and Human secretary Tom Price more leverage to further unwind Obamacare and enact conservative solutions. However, Republicans like Sen. John McCain et. al are effectively voting to keep Obamacare by not voting to end it.
Congressional Republicans have not learn't how GOP governors such as Scott Walker despite heavy opposition have enacted conservative reforms in otherwise blue states by properly making the arguments and eventually delivering benefits to their constituents. President Trump and the GOP could also learn how Missouri's GOP governor Eric Greitens has not squandered legislative and executive power and is quickly enacting pro growth conservative reforms.
The dis-unity within the GOP and needless distractions in the Trump presidency are wasting the political opportunities of a life time to enact reforms and justify conservative ideas as alternatives. At this pace, it won't be long before it becomes apparent that many loyal supporters who would normally want to hear these ideas don't think it is worth their time or money to do so.