GOP can’t agree on what’s wrong

As Supreme Court decision looms, party must unify on alternative

prescriptive scheme.

Yet tax credits could, in this view, be an important part of a reform that reduces the federal role in health care. That reform would pare back the total amount of subsidies offered, but more importantly use the subsidies to empower consumers and create competition among insurers and health care providers. It would avoid favoring employer-provided insurance over plans purchased by individuals (which federal tax preferences have done for six decades), allow cheaper and more expensive coverage to compete on a level playing field, and bring people into health insurance markets rather than relegating them to Medicaid’s inferior alternative.

This is the approach taken by several Republicans, who would make use of tax credits while also scrapping the plan’s mandates and regulations. The credits would enable the emergence of a competitive marketplace with little in the way of central direction. Being able to get the tax credits wouldn’t require meeting Obamacare’s definition of “essential benefits,” for example, or using one of its exchanges.

I have some sympathy for the conservative viewpoint that emphasizes the dangers of subsidies and the one that focuses on overregulation. I suspect that health care markets would work better if we had never created a tax break for health insurance decades ago, and if Medicare had been confined to the elderly poor. But if subsidization of health care is the decisive battle for conservatives, it was lost long ago. There aren’t more than a handful of congressmen who would be willing to scale back