This isn’t a new observation, here or elsewhere in the blogosphere. But it bears repeating now that the battle to thwart the Affordable Care Act is focusing almost exclusively on frightening people attached to their existing health care policies (or the lack of insurance altogether). Ezra Klein, as usual, expressed it succinctly today at Wonkblog:
Put very simply, you can’t reform the health-care system without disrupting the insurance some — or many — people currently get. That’s true for single payer. It’s true for Obamacare. And it’s true for every Republican plan, too….
John McCain’s 2008 plan would’ve been far more disruptive, as it would’ve upended the employer-based market. Single payer would be much more disruptive. Bill Clinton’s plan would’ve been much more disruptive. There’s no plan out there that actually fixes major problems in the system but doesn’t lead to some percentage of Americans waking up one day and finding their insurance arrangements altered, sometimes for the worse.
Ezra notes in passing that Obamacare was actually designed to minimize disruptions of existing insurance arrangements, and does so, relatively speaking:
An irony of this argument for health wonks is that one of the main critiques of Obamacare at the time of its passage was that the law did far too much to skirt around existing health-insurance arrangements. The cost of letting the vast majority of people keep what they had was making it impossible for most Americans to change what they had.
The insurance exchanges, for instance, are closed to large employers, at least for now. The (now-delayed) employer mandate is built to encourage employers to keep offering coverage rather than transition them to a new system. Those decisions were made because the Obama administration didn’t want employers moving to exchanges and changing the insurance people had. But that also means more time stuck in a costly, dysfunctional, employer-based system.
This conservatism about existing insurance has been obscured—or maybe even obliterated—by Obama’s “you can keep the insurance you have” assurances, which is one reason why Republicans are finding this angle of attack so irresistible (the other reason being that scaring healthy participants away from the exchanges undermines the whole design, which will then, of course, be blamed on the design). But by investing so heavily in a backlash from people who think they benefit from the pre-reform system, Republicans are politically weaponizing the status quo ante, and thus reducing prospects for enactment of their own pet health care proposals down the road.
UPDATE: MoJo’s Erika Eichelberger estimates that 19 million Americans would instantly lose health insurance altogether if Obamacare were repealed, and of course millions more would either lose insurance (the provision letting young people stay on their parents’ plans until 25) or see diminished coverage or higher premiums if the provisions of the Affordable Care Act already in place vanished. So one way of looking at it is that by acting as though everyone has an inalienable right to existing health insurance, GOPers are undermining both the “repeal” and the “replace” elements of their supposed health care agenda.
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