Poolside Fight

by Ramesh Ponnuru

Timothy Noah is annoyed by Republicans—when is he not? This time it’s because they are complaining about the high-risk pools in Obamacare when those pools are their own leading idea for health-care reform.

High-risk pools are, in fact, a terrible solution to the health-care crisis. But they happen to be the terrible solution Republicans most favor (along with tax breaks) whenever they’re forced to state their preferred alternative to last year’s Patient Protection and Affordable Care Act. They were the central idea in the health plan proposed by Republican presidential nominee Sen. John McCain, R-Ariz., during the 2008 election. They were the central idea in the House leadership’s proposed substitute for the Democratic plan in 2009, and they played a major role in the alternative plan set forth that year by Sen. Tom Coburn, R-Okla., a medical doctor who became the GOP’s lead opponent to Obamacare.

Risk pools weren’t McCain’s “central idea,” even if Noah can recruit a misleading NPR headline to represent them as such. His central ideas were replacing the current tax exclusion for employer-provided insurance with a tax credit for insurance however purchased, and allowing interstate purchases of insurance. Risk pools were, by comparison, an afterthought.

Noah claims that Republicans wrongly regard high-risk pools as “a long-term solution” to the problem of people who have difficulty getting insurance because of pre-existing conditions. Democrats favor them as a transitional measure, and their flaws are an argument, in his view, for getting to Obamacare’s new system. But Republican proposals would allow the development of a national market in individually purchased policies, and could therefore be expected to reduce the portability and fragmentation problems associated with employer-based insurance. The point of Republican high-risk pools, like Democratic high-risk pools, is to address a problem during the transition to a new system. The main difference between the models is the nature of the new system.

Anyway, there is no self-contradiction in Republicans’ complaints that Obamacare’s high-risk pools have not worked. I can see at least two possible arguments supporting the Republican position. First: The Obamacare legislation was poorly designed, and can be expected to yield perverse consequences; the failure of the high-risk pools it created is evidence of this failing. Second: High-risk pools are a necessary transitional measure, but they share the flaws and dangers of programs run by government bureaucracies; we should therefore be transitioning to a system that involves less reliance on government rather than on more.

P.S. Noah writes, “Republican attacks on Obamacare’s high-risk pools sound a lot like the old joke about the restaurant where the food is terrible—and such small portions! But the contradictory nature of the GOP’s complaints doesn’t rankle half so much as their fundamental hypocrisy.” I get the joke, of course, but there is no self-contradiction in wanting food to be both nourishing and delicious.