Friday, December 13, 2013

Why Do Republicans Hate Their Own Ideas on Healthcare?

Seriously, Eric, think about. If Obamacare turns out
well, we just claim it was a GOP idea. Win-win!

I've answered this question numerous times on a number of issues, but it all comes down to this: Republicans despise the poor. Any actual healthcare plan they could support would probably somehow help the unfortunate, and that's a bridge too far.

And now that a budget deal -- regardless of how it hurts the poor and the unemployed, by the way -- has been crafted, yes, in bipartisan fashion, and now that Obamacare seems to be working, or at least on its way to being acknowledged as settled law, the GOP is having a harder and harder time finding ways to attack it.

Almost on cue, a number of leading minds in the progressive camp, like Ezra Klein, Paul Krugman, and Johnathan Chait, have started to analyze the continuing Republican attacks on Obamacare. It's almost like trying to find some intentional message in the twitching of a still-warm corpse.

And they find it! I largely agree with their views, and they're fascinating.

Klein starts by being puzzled that the continuing attacks on Obamacare are aimed at the parts of the law the GOP can truly claim as their own ideas. Then he goes one by one through the items the GOP continue to attack.

Klein points to high deductibles, which are actually a crucial component of Health Savings Accounts, long a GOP favorite. The idea there is that you can easily afford a plan with high deductibles as long as you have saved money in an HSA for that rainy day when you get catastrophically sick.

Another GOP idea Klein points to is limited networks. Again, they were crucial to early Republican ideas. Every GOP plan in the past featured insurance exchanges, meant to let the market solve costs through competition. A natural result of that competition for lower-cost plans would be offering less without reducing available quality of care. Narrowing doctor and hospital choice would do that.

There are two contrasting reasons, according to Klein that the Republicans are blasting their own ideas: They're the ones that are the most unpopular among Americans! There are all sorts of progressive components in the law -- no caps on lifetime expenses, no refusal of insurance because of pre-existing conditions, no plan on any level can have huge coverage gaps you don't know about until you get sick or hurt, keeping your kids on your own plan until they're 26. These are the wildly popular parts of Obamacare.

Paul Krugman reads Klein and comes up with a different perspective, one closer to my view.
And here’s the thing: Republicans don’t want to help the unfortunate. They’ll propound health-care ideas that will, they claim, help those with preexisting conditions and so on — but those aren’t really proposals, they’re diversionary tactics designed to stall real health reform. Chait finds Newt Gingrich more or less explicitly admitting this.
Hence the rage of the right. Here they were, with a whole raft of ideas they could throw out, like chaff thrown out to confuse enemy radar, to divert and confuse any attempt to actually provide insurance to the uninsured. And those dastardly Democrats have gone ahead and actually incorporated those ideas into real reform.
Once you realize this, you also realize that people who warn that by opposing Obamacare Republicans are undermining their own proposals are missing the point. Yes, the Ryan plan to privatize Medicare looks a lot like Obamacare — but Ryan comes to Medicare not to save it, but to bury it, so the question of whether his plan could work is irrelevant.
That rings bells with me. And the Jonathan Chait article that Krugman references takes this idea that the Republicans were never really serious in their claims to have ideas or were in favor of reforming our healthcare system and gives a name to it:
The question should be posed to better-trained philosophical minds than my own. I would posit that conservative health-care policies do not exist in any real form. Call it the “Heritage Uncertainty Principle.”
I take the name of this principle from the emblematic example, the Heritage Foundation’s health-care plan, which formed the primary intellectual basis for conservative opposition to Democratic health-care plans. In 1993, Republican minority leader Bob Dole supported a version of it to demonstrate that Republicans did not endorse the status quo, until Democrats, facing the demise of their own plan, tried to bring up Dole’s plan, at which point Dole renounced his own plan.
During a Republican presidential debate two years ago, while Newt Gingrich assailed Mitt Romney for having previously supported an Obama-like health-care plan, fellow Republicans noted that Gingrich had done the same thing. Facing a threat to his own ideological bona fides, Gingrich issued this memorable defense for his long-renounced history of support for the individual mandate: “It's now clear that the mandate, I think, is clearly unconstitutional. But, it started as a conservative effort to stop HillaryCare in the 1990s.”
This may be the most incisive expression of conservative health-care thinking ever uttered. In the first sentence, Gingrich asserts that the individual mandate is now clearly unconstitutional, even though its constitutionality was deemed not even remotely questionable before. And in the next breath, he casually admits that he had supported the plan as a mere tactic to stop Clinton. Of course he didn’t really want to implement it!
The Heritage Uncertainty Principle could likewise be seen at work throughout Obamacare’s torturous legislative path to enactment. Republicans had all kinds of health-care ideas they wanted to discuss. Oh, the ideas they had. Republican senators like Olympia Snowe and Charles Grassley flitted tantalizingly out of reach for months, always willing to keep talking, but never able to identify concrete terms that might win their vote. Ron Wyden convened a large, bipartisan group of senators happily discussing an alternative health-care plan to Obama’s, except that, when pressed, the Republican co-sponsors admitted that they didn’t really want to vote for the actual plan. They just liked the idea of a bipartisan plan that wasn’t Obama’s. Any attempt to turn these ideas into an actual law would cause them to disappear instantly.
Good stuff. It reminds me of vaporware, which Wikipedia describes as "a product, typically computer hardware or software, that is announced to the general public but is never actually released nor officially cancelled." A current example: Apple television sets, which were announced in 2007 but so far, nothing. Hmm.

So "repeal and replace?" Just so much vaporware.

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