Absence of Obamacare Replacement Exposes Republican Deception

Republican opposition to Obamacare was empty rhetoric. They have no idea how to turn their slogans into policy.

President Donald Trump, House speaker Paul Ryan and Vice President Mike Pence of the United States meet at the Capitol in Washington DC, November 13, 2016
President Donald Trump, House speaker Paul Ryan and Vice President Mike Pence of the United States meet at the Capitol in Washington DC, November 13, 2016 (Facebook/Speaker Paul Ryan)

Something must be seriously wrong if I’m on the same side as Paul Krugman.

The economist writes in The New York Times that it isn’t just Donald Trump who is incompetent but his entire political party that has been faking it for years.

Its leaders’ rhetoric was empty; they have no idea how to turn their slogans into actual legislation, because they’ve never bothered to understand how anything important works.

That last bit is ungenerous. The reality is that Republicans have put politics over policy, but Krugman — unfortunately — isn’t altogether wrong.

Where is the Obamacare replacement?

Look at health care.

As Krugman points out, the Republicans have had seven years to come up with an alternative to the Affordable Care Act. Now they are in power. Where is the plan?

Krugman believes the reason Republicans are struggling to come up with an alternative is that they have belatedly discovered what people like him said all along: “The only way to maintain coverage for the twenty million people who gained insurance thanks to Obamacare is with a plan that, surprise, looks a lot like Obamacare.”

I opposed Obamacare, but I have come around on its core component: the individual mandate.

Unless you want government-run health care — and let’s not forget that government already spends around $1 in every $2 that’s spent on health care in the United States through Medicaid and Medicare — you need an insurance mandate to come close to universal coverage. It is the most market-friendly way to do it.

A few ideas

That doesn’t mean Obamacare doesn’t need reform. I would get rid of requirements that say insurance plans must, at a minimum, cover everything from maternity to mental health care. If you’re a man with no history of mental illness, why should you insurance yourself against the costs of childbirth and psychiatric treatment?

I would also weaken licensing requirements that preceded Obamacare. For example, allow nurses to perform relatively simple medical procedures and create a nationwide insurance market.

More fundamentally, encouraging Americans to get insured through their employers is illiberal. The tax system ought to be changed to shift that incentive 180 degrees. You shouldn’t lose your health insurance when you lose your job, nor should you be afraid to quit your job because you can’t afford to lose your health insurance.

All this would be part of a comprehensive, right-wing health reform plan. But it isn’t. Because there is no plan.

Will the Republican fever break?

What we’re seeing, writes Krugman, is the consequence of a party that has given up hard thinking in favor of empty sloganeering.

Perhaps the responsibility of governing will sober them up?

As Andrew Sullivan put it in New York magazine recently, being confronted with the project of running the country may just cause the Republican “fever” to break.

This goes beyond simple-minded opposition to Obamacare:

The Republican base’s talk-radio politics, their Breitbart alternative facts, their railing constantly about Obama’s various alleged iniquities — none of that is enough to actually govern. But that is all they have known for so long. At some point, the Republicans are going to have to raise the debt limit; they are going to have to pay for the wall; they’ll have to replace the ACA with, well, er, something quite fabulous. They have no excuses anymore, after all.

Every serious center-right person should hope he’s right. The alternative is two, possibly four, perhaps eight years of non-government.