Political Animal


April 23, 2012 12:43 PM Repealable But Not Replaceable

By Ed Kilgore

One of the positive byproducts of the looming threat that the Supreme Court will declare the Affordable Care Act (or key elements of it) unconstitutional is that more attention is gradually being paid to what, exactly, ObamaCare’s Republican critics would do to deal with the cost, access and quality issues it was designed to address.

There’s a solid new LA Times article by Noam Levey that provides a good refresher course on Mitt Romney’s latest health care proposals, which are sort of an amalgam of what George W. Bush and John McCain proposed a few years back, along with the Ryan Budget’s treatment of Medicare and Medicaid.

But TNR’s Jonathan Cohn has the best succinct description of how it all adds up:

Estimates of House Budget Chairman Paul Ryan’s proposal, which Romney has embraced and which would likely be similar to his approach, have suggested that the cuts to Medicaid alone could take health insurance away from between 14 and 27 million people. That’s not including those who would lose out on coverage they stand to get, right now, from the Affordable Care Act.
Not that Republicans seem to care much. They like to say their focus is on “cost” as opposed to “coverage.” I’m sure it’s an effective line politically: It suggests that Republicans are focused on the deserving insured, while Democrats are spending their time (and your money) on the less deserving uninsured.
But that claim highly misleading. Under the Republican proposals, insurance would become cheaper mostly because it would cover less and would be available to fewer people who need it. Conservatives believe their system would encourage competition, but, more likely, it would encourage the kind of competition we have already: A competition among insurers to insure the least risky beneficiaries, rather than a competition to provide more efficient care to people who actually need medical care.

So the “Replace” in the GOP “Repeal and Replace” agenda for health reform is a complete fraud in the sense that it does not even attempt to address the challenge of achieving universal access to affordable health care. The last large-scale effort by a Republican politician to do that was in Massachusetts, and it depended strictly on a federal commitment to Medicaid that its author now wants to scrap, along with a national version of his own handiwork. “Repeal and Ignore” would be a more accurate slogan.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • Mitt's Magic Underpants on April 23, 2012 12:54 PM:

    See??? Unfettered, unrestricted markets work! Down with government, up with Romney!

  • Diane Rodriguez on April 23, 2012 1:03 PM:

    The Republican health care agenda seems to believe that people who are not insured will just not get sick or not seek health care or perhaps as Congressman Grayson put it “just die quickly”. In the real world, the emergency room becomes both the first and last resort for care. If it is health care of the first resort, costly ER resources are consumed as opposed to an office visit. In the last resort, admittance to the hospital for an acute condition is much more costly than treatment at an earlier stage. Someone assumes the cost, certainly not private insurers. The cost is passed on to consumers, low risk or not. All the talk about costs doesn't even consider the more ethical concerns about who gets treatment, when and of what quality or how the financial burden devastates people.

  • TCinLA on April 23, 2012 1:17 PM:

    You have to admire the consistency of the Republicans. Everything they believe in is a "complete fraud."

  • Mudge on April 23, 2012 1:22 PM:

    The Republicans are lying sociopaths. Or is it sociopathic liars. We all know the costs will not go down, coverage will go down and profits will go up.

  • SadOldVet on April 23, 2012 1:35 PM:

    Repeal and replace with the same fail we had before!

    Repeal and replace with higher profits for the health care industry!

    Repeal and replace with more wealth for the wealthy!

    Repeal and replace with an increasing shrinking of the 'middle classes'!

    Repeal and replace with profit driven death panels run by corporate bureacrats!

    Craptcha say "Kongool Insult" --- Kongool must be a new name for republicans

  • boatboy_srq on April 23, 2012 1:44 PM:

    Why should we expect anything less from a party that treats Bleak House and The Jungle as instruction manuals?

  • howard on April 23, 2012 1:45 PM:

    the question is whether obama and various dems will call them on it, given their fear of anti-obamacare passion.

  • ajw93 on April 23, 2012 1:48 PM:

    "...what, exactly, ObamaCare’s Republican critics would do to deal with the cost, access and quality issues it was designed to address."

    I'll tell you what: Nothing. Nothing at all.

  • jjm on April 23, 2012 2:24 PM:

    As I see it, the real conflict going on right now, and it is not confined to the USA, is that "the markets" wish to be the exclusive, unelected government.

    That is the basis of the conservative/right wing hatred of the government--meaning ONLY democratically elected governments that might not kowtow to their dictates. What, after all is ALEC except the advance guard of this? The Markets apparently don't even care for corporations' wishes in their demand to rule absolutely

    Wonder when people will become weary of the dictatorship of the markets? Especially since 'the markets' run not on reason and ethics, but on rumor, imaginary money, and unethical behavior?

  • DaveM on April 23, 2012 4:08 PM:

    " does not even attempt to address the challenge of achieving universal access to affordable health care."

    No, you're not going to get your way. You already tried that, and zero Republicans went along with it. Look how that turned out.

    You're going to have to COMPROMISE. Remember that word? You can't go into this new phase expecting universal access, because HALF OF THE COUNTRY doesn't agree with you.

  • zandru on April 23, 2012 4:37 PM:

    Much of the various Republican health care proposals seems to depend upon sick and injured people being allowed to die in the streets, at the doors to doctors' offices, and in the waiting area of the ER when they don't have the cash or the proper level of insurance coverage. Or, alternatively, in their homes or at the accident site if they can't show coverage or cash.

    Will this fly in America? Well, we all reveled in torture and made "24" one of the most popular shows on the teevie just a few years back, so I'm sort of worried.

  • Jimo on April 23, 2012 5:54 PM:

    "Not that Republicans seem to care much. They like to say their focus is on “cost” as opposed to “coverage."

    I can't say this too often: "costs" do not disappear just because you refuse to pay.

    Shifting "costs" from the government's balance sheet and onto society at-large not only saves nothing but is likely to result in even greater expenses as preventable and manageable illness becomes catastrophic via non-treatment.

    In short, the goal here is to limit medical costs at the macro level (via efficiency), not shifting fixed costs from one pocket to another.

  • Pronghorn on April 24, 2012 12:00 AM:

    The unspoken assumption is that the only way to improve healthcare is to create a massive Federal government experiment, toss everyone into it, and hope for the best. So the Republicans must have a competing Federal experiment to replace the existing Obama one. Reject that view and insist on 50 experiments, one in each State, so we can test many ways to improve healthcare, reduce costs. Get the Federal government completely out of the healthcare business.

  • bob h on April 24, 2012 7:01 AM:

    Killing Obamacare would result in such chaos and anger, with 70 million uninsured in a few years, that a President Romney would probably be forced to re-enact something resembling it in time. And the Supreme Court would not lay a glove on it.

  • civarifsciz on January 17, 2013 2:44 PM:

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