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Health Care and a Political Malaise

Repeal and replace. Repeat.Repeal and replace. Repeat.
Repeal and replace. Repeat.

Good morning.

The heated debate over the fate of the Affordable Care Act, which raged throughout the weekend, says as much about what’s wrong with the U.S. political system as it does about what’s wrong with the U.S. health care system.

Conservatives who claim the House bill is “Obamacare lite” have a point. “Repeal and replace” overstates what is going on here. Republicans are tweaking the system to reduce the heavy hand of government by 1) eliminating the mandate that everyone must buy coverage, 2) increasing the flexibility of insurance companies to offer streamlined and less expensive plans, and 3) reducing the overall cost to government. The basic structure remains intact, as was inevitable.


The real problem is political. A sustainable fix to the health care system will only happen on bipartisan terms. The Affordable Care Act overreached in part because it had to accommodate the demands of all Democrats to make up for the fact it wasn’t going to win support of any Republicans. “Repeal and replace” now faces the opposite problem—Congressional leaders may have to cater to conservative critics because no Democrats will support them. If they give in to conservative demands—and possibly even if they don’t—they run the risk of adopting a bill that deprives GOP voters of benefits and will be rejected at the polls in 2018, empowering a new crop of Democrats committed to repealing and replacing the repeal and replace.

“When you jam something through one party over another, it’s not sustainable. It becomes a point of attack,” the Republican Governor of Ohio John Kasich said yesterday on Meet the Press. “We need to have Democrats involved so that what we do will not only be significant, but will last.”

Which gets back to our broken political system. As I mentioned here Friday, the new issue of Fortune has an interesting and important essay by Katherine Gehl and Michael Porter that uses competitive strategy to analyze the political industry. Their conclusion: it’s a classic duopoly—good for the health of the two parties, but bad for the health of the country. The time has come for reforms of redistricting, the primary process, and elections, to open the process to people in the center.

News below. And apologies to the folks at Ingredion for saying Friday that they make “artificial sweeteners.” They make sugar substitutes, but with natural ingredients.