Ezra Klein has a lengthy piece taking apart my post from last July concerning the media’s oft-repeated “Republicans Have No Obamacare Replacement” myth.
I’m glad he’s engaged on this point, because I think it’s a sign of seriousness and a positive development to have debates about what comes after Obamacare – because make no mistake, something will come after it – and the discussion has been a long time coming.
The essential premise of Ezra’s piece is that Republicans have no plan for replacing Obamacare because none of the Republican plans does the same things Obamacare does, at least on paper. In other words, to qualify as an Obamacare replacement, your plan has to accomplish pretty much the same thing, with pretty much the same methods. This strikes me as a bit of a game, especially given the conflation of ends and means: if I replace my Ford with a Honda, do I still have a car? Or my desktop with my laptop – do I have a computer? Or sugar with Splenda… you get the idea. But then Ezra goes on to spend 2400+ words criticizing Republican plans. This itself is a welcome acknowledgement that these Republican plans must in fact exist, which was the whole point of my original post. Ezra’s real contention is not "You have no plan", but "Your plan is all wrong." Good! Now, four years later, we can have a debate.
The eight points that I noted as principles shared by the overwhelming majority of Republicans approach health care from a different perspective than Ezra and the Democrats. The accusation on Ezra’s part is that Republicans think we have too much insurance. He’s basically right – but there is a difference between saying “we have too much insurance” and saying “we have too many people insured”. It’s important to be careful here, because we’re judging how a Republican plan would work against how Obamacare’s supporters claim it would work, or ought to work. Democrats see getting insured as an end; but for Republicans, more healthy people is the end.
What most of the conservative health policy experts on the Right want is greater access to quality, affordable care. They understand health insurance does not guarantee quality health care any more than car insurance guarantees you a mechanic who fixes what's actually wrong with your car without overcharging you. They want people getting insured because insurance is more affordable, competing in a marketplace to provide people with what they want – and thus Republicans are focused on cost, while Democrats are focused on coverage.
Ezra argued recently that it’s okay that we’re seeing premium hikes, because people are paying for better insurance. But that's a bait and switch. Obama didn't promise that Obamacare would have people paying more for a better product – he promised premiums would go down $2500 and that most people would keep the same insurance and the same doctor they had before. Affordability was how he led with it – it’s right there in the title: the Affordable Care Act! Yeah, about that. And it’s an open question, I think, about whether these plans are really any better. For those getting regular email updates from their insurer about the subtle tightening of the reins on access to certain procedures, it looks more like insurance is getting more expensive while covering things Washington deems more important than what they covered before – which may or may not be what you need at an individual level.
Republicans are in this cost-focused position in part for populist reasons: cost is what most Americans care about. According to a March 2009 report released by Health and Human Services, a majority of Americans identified cost as their top concern with American health care – not coverage. See U.S. Department of Health and Human Services, “America Speaks on Health Reform: Report on Health Care Community Discussions,” page 101. It used to be online here, but HHS has taken it down for some odd reason.
Read more: http://www.realclearpolitics.com/articles/2013/04/04/unlike_obamacare_the_republican_plan_will_work_117796.html#ixzz2PVQNIVUO
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