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Reihan Salam Of 'National Review' On The GOP's Options For Health Care


Last night, Senate Majority Leader Mitch McConnell said the Senate will delay taking up their health care bill while Senator John McCain recovers from surgery. It's just another sign of how tight things are when it comes to the latest plan to overhaul the Affordable Care Act. The Republican Party remains divided on exactly how much of a role the federal government should play in health care. Reihan Salam is the executive editor of the conservative magazine National Review, and he joins us now.

Thanks for being with.

REIHAN SALAM: Thanks for having me.

GARCIA-NAVARRO: So has the country now decided it likes having the government involved in health care? The Affordable Care Act is the law of the land, and polls show that people actually now like it.

SALAM: We have seen movement in the polls over the last several years. And now you have a comfortable majority of people who say that they believe that the federal government should guarantee universal health coverage for all Americans. One thing to keep in mind is that when - pretty much whenever any new social program comes into effect, it creates a constituency and that it really changes the politics around a given issue because basically, you know, people are fearful of losing benefits they've already acquired.

GARCIA-NAVARRO: Yeah. I mean, essentially, people don't want things taken away from them that they feel they've already been given. Is that what the Republicans are facing right now?

SALAM: That's certainly a big part of it. So when you're looking at market democracies, when you do try to shrink a program, when you try to change how a program works, the only way you could really successfully do it is by saying, look, we're going to take the most vulnerable people, and we are going to protect their interests while we're going to change the program to make it more cost effective to make it more sustainable over time.

That's still not always easy, but that's a message that can succeed. If, however, you have a muddled message, if it seems like you're planning on having some retrenchment of a program for no good reason, you're not articulating a good and compelling reason to do it. That tends to be much, much worse.

GARCIA-NAVARRO: There is a paradox. The Affordable Care Act has become popular, as we mentioned, but in the same polls when you ask people about Obamacare, they say that they don't like it. Now that Obama is out of office, are people paying more attention to the actual policy and its effect on their lives?

SALAM: Well, what I'd say is that earlier on, I pointed out to the fact that if you look at surveys, you find that people say that the federal government should insure universal coverage. Now, of course, there are lots of ways to go about doing that. As for Obamacare in particular, it certainly has created some constituencies. But are there ways to change the law that would be broadly popular? I think the answer is yes.

But to do that, you'd really need to have a coherent, unified critique of Obamacare. And that's the big problem for Republicans because if you're looking at Republican objections to Obamacare, they've come from pretty much every direction. People have criticized it for all kinds of reasons that are oftentimes somewhat contradictory. And that means that you don't have a kind of common narrative about, what's the problem here that we're trying to solve?

GARCIA-NAVARRO: And one of the other reasons is, of course, because there are so many different views within the Republican Party. Senate leader Mitch McConnell is using the threat of bipartisanship now to whip his conservative members into backing the BRCA (ph). But wouldn't repairing the existing law actually get them a political win, the one that they need?

SALAM: Well, one issue is, what exactly does it mean to repair the existing law? If you're looking at something like the Cassidy-Collins proposal and now the Graham-Cassidy proposal, there are some proposals coming out of the Republican side that involve, you know, basically measures that are not going to be such radical changes to the status quo. But then, you know, more broadly, if you look at both the AHCA and BCRA...

GARCIA-NAVARRO: Those are the House and Senate bills.

SALAM: That's exactly right. Both of these legislative proposals aren't actually repeals of Obamacare. And that's one thing that some folks on the political right lament, but they really don't actually get rid of the central regulatory dimensions of Obamacare that ironically enough are the things that conservatives really objected to all along. You'll find a lot of people on the right, you know, for the last 20 years, who would have said, sure, you might need premium subsidies, you might need sliding scale subsidies, et cetera.

The real objection was actually to the centralization of regulation. And that's the stuff that is fundamentally being preserved. So you have this tricky situation where because we don't have bipartisanship - because you can't really get 60 votes, you know, Republicans find themselves in a real bind. They can't really do all of what they'd want to do. And so they find themselves being forced to defend these proposals that they don't really have full ownership of, they're not necessarily that enthusiastic about.

GARCIA-NAVARRO: Reihan Salam is executive editor of National Review. Thank you so much.

SALAM: Thank you. Transcript provided by NPR, Copyright NPR.