GOP finally realizing cost of its long con on Obamacare

Paul Krugman

Some Republicans appear to be realizing that their long con on Obamacare has reached its limit. Chanting “repeal and replace” may have worked as a political strategy, but coming up with a conservative replacement for the Affordable Care Act — one that doesn’t take away coverage from tens of millions of Americans — isn’t easy. In fact, it’s impossible.

But it seems nobody told Donald Trump. In Wednesday’s news conference, he asserted that he would submit a replacement plan, “probably the same day” as Obamacare’s repeal — “could be the same hour” — that will be “far less expensive and far better”; also, with much lower deductibles.

This is crazy, on multiple levels.

The truth is that even if Republicans were settled on the broad outlines of a health care plan — the way Democrats were when President Barack Obama took office — turning such an outline into real legislation is a time-consuming process.

In any case, however, the GOP has spent seven years denouncing the ACA without ever producing even the ghost of an alter- native. That’s not going to change in the next few weeks, or ever. For the anti-Obamacare campaign has always been based on lies that can’t survive actual repeal.

How have Republicans nonetheless been able to get away with this? Part of the answer is that many of the newly insured don’t know that they’re being covered via Obamacare, or at any rate don’t realize that they will lose coverage if it’s repealed.

But that will change if repeal proceeds. For example, the percentage of nonelderly white adults without insurance fell by almost half from 2010 to 2016, from 16.4 to 8.7, a gain surely concentrated in the Trump-supporting white working class. Repeal would send that number right back up.

Meanwhile, Republicans have made hay over this year’s increase in insurance premiums. But this looks very much like a one-time adjustment; and the broader picture is that health costs have actually gone up much more slowly since Obamacare was enacted than they did before, in part due to the law’s cost-control features, which have worked far better than most expected.

And if the ACA is killed, myths about its costs will be replaced by the reality of soaring bills for millions of Americans who don’t realize how much the act has helped them.

But won’t Trumpcare solve all these problems, by offering something much better and cheaper? Not a chance.

Republicans don’t have a health care plan, but they do have a philosophy — and it’s all about less. Less regulation, so that insurers can turn you down if you have a pre-existing condition. Less government support, so if you can’t afford coverage, too bad. And less coverage in general: Republican ideas about cost control are all about “skin in the game,” requiring people to pay more out of pocket (which somehow doesn’t stop them from complaining about high deductibles).

Implementing this philosophy would deliver a big windfall to the wealthy, who would get a huge tax cut from Obamacare repeal, and it would mean lower premiums for a relatively small number of currently healthy individuals — especially if they’re rich enough that they don’t need to worry about high deductibles.

But the idea that it would lead to big cost savings overall is pure fantasy, and it would have a devastating effect on millions.