Conservatives need a reality check on health
Republicans in Washington have failed to deliver on their signature campaign promise to repeal Obamacare despite controlling the House, Senate and White House. The most common accusations — inept management, poor leadership, rogue senators — identify only symptoms of a larger problem. The root cause is that compared with Democrats, Republicans have far less clarity of purpose.
Democrats have two advantages. One is a shared goal of universal coverage achieved through aggressive government intervention. The other is their willingness to achieve that goal incrementally.
Obamacare did not achieve universal coverage — the percentage of uninsured Americans has fallen from 14.6% in 2008 to
11.3%. But that’s progress, and it has brought more left-wingers on board.
Among Republicans, there is broad agreement only on the political goal: repealing Obamacare. There is no agreement on the principles, never mind the details, that would guide replacement.
The ideological diversity of the GOP is one reason for this. Democrats have a spread, too, but they are more united. For instance,
83% of them say the federal government “has a responsibility to ensure health coverage for all,” according to Pew Research data. Nearly a third (29%) of Republicans agree, but two-thirds disagree.
The other reason is that health care does not lend itself to quick “get the government out of the way” fixes. The health care mar- ketplace is thoroughly distorted by government interference (this was true well before Obamacare). These distortions have to be slowly and carefully unwound. Many of them have grown popular, so no majority can be found for quickly abolishing them. The political reality is that government’s heavy hand will not be removed any time soon — because most voters don’t want it to be.
Another factor: Medicaid made up 28% of state budgets in 2015, which explains why so many Republican governors pushed back against the last Obamacare repeal bill. (For comparison, elementary and secondary education accounted for 19.5%.)
Conservative analyst Avik Roy offered a plan in 2014 that would replace Obamacare with Swiss-style subsidies for lower-income Americans while transitioning the inefficient government-run Medicaid program toward a more market-oriented system.
It would be an improvement over the current system, yet it is not even considered because it is not free-market enough for most Republicans. Opponents to options such as this one pretend that the alternative is a true free market in health care. It isn’t. There is no appetite for a true free market at the moment. The alternative to a transitional model is the status quo.
We can either move incrementally toward a freer market, or we can drift toward single-payer. Those are the options. If Republicans cannot agree on that, then Obamacare really is here to stay.