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August 20, 2013 10:09 AM Why There Is No Obamacare “Replacement” Agenda

By Ed Kilgore

In some pretty classic news-the-listener-doesn’t-want-to-use, Newt Gingrich told the Republican National Committee meeting in Boston this week that Republicans needed to get their act together and offer some kind of alternative to the Affordable Care Act of 2010 if they want to win the “war on Obamacare.” Per Bloomberg’s John McCormick:

Saying that most Republican lawmakers have “zero answer” for how they would replace “Obamacare,” Gingrich also said, “We are caught up right now in a culture — and you see it every single day — where as long as we are negative and as long as we are vicious and as long as we can tear down our opponent, we don’t have to learn anything.”
He termed that approach “a very deep problem.”
“If we’re going to take on the fight with Obamacare, we have to be able to explain to people what we would do to make your life better,” Gingrich, a former U.S. representative from Georgia and House speaker, later told reporters. “It can’t just be going back to the world that led to Obamacare.”

I dunno. Some of what passes for health reform “thinking” in the GOP these days makes the status quo ante in health care seem safe and reasonable. But as Ezra Klein points out today, the most immediate problem for conservatives is that they have rejected, with growing hysteria, their own “reform” heritage, and don’t have much to fall back on:

[F]or all Gingrich’s bluster on the subject, the simplest way to understand that policy vacuum is to understand Gingrich’s pre-Obamacare health-care plan: It was Obamacare.
“We should insist that everyone above a certain level buy coverage (or, if they are opposed to insurance, post a bond),” he wrote in his 2008 book, ‘Real Change.’ “Meanwhile, we should provide tax credits or subsidize private insurance for the poor.”
So that’s an individual mandate plus tax subsidies to purchase insurance. That’s the core of Obamacare. And it’s no surprise Gingrich supported it. Lots of Republicans did. Gov. Mitt Romney had even signed a plan like that into law in Massachusetts.
Conservative elites had two options when Democrats began to adopt their policy ideas: Declare victory or declare war. Key figures like Gingrich could’ve stepped before the cameras and chortled about Democrats giving up on single payer and slinking towards conservative solutions. For Hillary Clinton to run in 2008 with Bob Dole’s health-care plan was an amazing moment in American politics. For Barack Obama to reverse himself on the individual mandate and embrace the Heritage Foundation’s approach to personal responsibility was further proof that Democrats had lost the war of ideas here.
Republicans could have declared victory and, by engaging constructively, pushed the final product further towards their ideal.
They chose war instead. And that meant eradicating any trace of support for the policies they had come up with.

If you go back far enough to recall that what became Medicaid was originally a Republican alternative to universal health coverage, the repudiation of their own ideas in the war on Obamacare becomes pretty much complete.

But the GOP’s problem on health policy goes deeper than having to erase their own tracks. There are three persistent obstacles to the development of a conservative “replacement” for Obamacare.

(1) A growing tendency to oppose the very idea of redistribution of risk and cost, which is essential not just to public health reform efforts, but to private health insurance. Conservatives often seem to want to go back to those days when patients paid doctors with cash or did without health care altogether. That’s “personal responsibility” with a vengeance.

(2) An inability to accept the need for national regulation of health insurance. The single biggest trap for Republicans on health policy right now is the wild popularity of measures to end discrimination against people with pre-exisisting health conditions. There is no way to effectively make that happen without national regulation of health insurers. Instead, GOPers are moving in the opposite direction, with their “interstate insurance sales” gimmick that effectively preempts state regulation of insurers without substituting federal standards.

(3) A habit of opportunistic defense of the status quo. Is there any bad feature of the health care status quo that Republicans haven’t championed in their fight against Obamacare? I can’t think of any. They’ve cheered for strict fee-for-service medicine, letting providers determine their own Medicare and Medicaid payment rates and maintaining higher public subsidies for expensive Medicare Advantage plans. And they’ve opposed virtually every effort to bring down health care inflation that doesn’t simply reduce benefits or shift costs to consumers. It’s hard to be for “reform” when you’re running around frightening old folks with bogus threats to Medicare as they know it. And when you’ve turned the very idea of public efforts to restrain health care costs into “rationing” and then “death panels,” how can you engage in sensible discussions on this topic at all?

I don’t know how the GOP overcomes these problems without a significant change of course. It’s not like Republicans can just instruct the wonks at their think tanks to go back to the drawing board and come up with something new and cool now that the party has rejected their last generation of health care ideas. Such ideas simply may not exist without a change of philosophy. And so GOP pols keep going back to the same pet rocks like Health Savings Accounts and interstate insurance sales and high-risk pools, which don’t make any more sense than they did twenty years ago. It would almost be funny if real lives were not at stake.

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.

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