In a New York Times op-ed on Sunday, Ramesh and I argued that along with the Ryan budget Republicans need to unite behind a clear alternative to Obamacare, and that a modified version of the McCain tax credit idea from 2008 would serve them well—on both policy and political grounds.
The most serious liberal response to our piece was from Matt Yglesias, who argued (and was echoed by several other prominent liberal bloggers in arguing) that this idea had some merit but that it would fail to address the problem of adverse selection. In the individual market we envision, he argued, insurers would only cover the healthy and young. And the only way to do anything about that is to follow Obamacare’s structure and approach.
You can find our response on the homepage today. Simply put: there are better ways to address the problem of adverse selection and help Americans with pre-existing conditions get insured. The idea that dealing with this problem is the case for Obamacare is a little odd.
It has been very interesting to see in recent months how the defense of Obamacare has narrowed and shrunk. It is now common to find defenses of the sort Yglesias offers, which treat Obamacare as though it does one narrow thing (in this case address the pre-existing condition issue) and ignore the fact that it is actually a profound transformation of our health-care system in the direction of far greater dominance of that system by the federal government, vastly increasing Washington’s already very large and counterproductive role as a regulator and provider of coverage. You see the same thing in the bizarre argument made by some defenders of Obamacare that conservatives who like the idea of reforming Medicare in the direction of a premium-support system should like Obamacare since that’s all it does to our larger health-care system. This, again, takes a small part for the whole (and badly distorts that part along the way).
Defenses of Obamacare as a whole are now pretty hard to come by. That’s no surprise, since Obamacare as a whole is an incoherent mess that would take our health-care system in exactly the wrong direction. That’s why it needs to be undone as a whole, and replaced with reforms that are actually directed to the problems we have, and above all the underlying problem of rising health-care costs.
I wholeheartedly agree to the idea that the Repubs must come up with another alternative to healthcare reform. Simply "Repeal Obamacare" is not going to cut it! Instead let's go with "Replace Obamacare!" That's going to resonate more with voters, esp. Indie like me. I'm simply do not understand why the Repubs in Congress do not form an ad hoc Healthcare Reform Working Group. Get Tom Coburn or John Barrosso (sp?), Tim Johnson (WI) from business perspective, several of House Repub. physician/healthcare professional-congressmen/women (many of those elected last election), throw in a Paul Ryan from economist perspective, a Constitutional laywer, etc altogether come up with a real, market- based, autonomy/individual liberty-preserving, viable alternative to Obamacare with the added bonus of transparency (who's who) for the American people to see. I do not why that's not a winner in the '12 election, and why Repub. strategists/consultants have not investigated that. Seems to me a "no brainer" of an issue. Boggles the mind, really!
Reply to this commentLinkReport AbuseAlternative Healthcare: this is already a very widely researched area. See Cato, Heritage, Assoc. American Physicians and Surgeons. All these politicians need to do is grow a set.
Reply to this commentLinkReport AbuseEven with pre-existing conditions the Obama Care supporters are looking at smaller and smaller categories of people for who pre-existing conditions make sense. They seem to get unqualified support for lost or changed jobs and for babies born with birth defects. Both of those do need an answer, and separating health care from employment at least partially addresses the first one.
The opponents of Obamacare got a lot of traction with the scenario someone getting in an accident and calling the insurance company from the Ambulance to buy service.
Reply to this commentLinkReport AbuseYuval,
Can I push back a bit on the oft-referred to but to my mind chimeral “underlying problem of rising health-care costs”?
Is there any treatment that is more costly, in constant-dollar terms, than qualitatively equivalent treatment from a generation ago? It is hard to imagine treatments that are unchanged over time, but there are many that are roughly comparable in outcome, e.g. childbirth. When I consider the simple process (relatively speaking) of delivering my children (full credit where due – my wife did the heavy lifting, not me), and compare it with what I have heard of the routine extravagance of my own birth (and others of the same era), it seems to me that health care costs are going down, not up, thanks to improvements in procedures, recovery times, transition to outpatient care, etc.
Isn’t it our appetite for health care that is exploding, rather than the (per unit) costs of care?
Kristo Miettinen
Reply to this commentLinkReport Abuseheh, here is an idea ... how about we repeal ObamaCare first ....
Then we have an open public debate over how to improve heathcare ? You know the kind of debate we didn't get with ObamaCare ... a debate that doesn't just have the special interests/unions in the room gaming the proposal, again like what happened with ObamaCare ...
Americans will tell the GOP what they want after it is debated in public ...
The GOP does not need a replacement plan hammered out behind closed doors like we got with ObamaCare ...
If you think you can have a plan without a long public debate, guess what, you are just plain wrong ... why, because almost anything decided by a committee in DC will try to be a one size fits all model that just will not work ...
Reply to this commentLinkReport AbuseSince our healthcare has been so affordable up to now - maybe we should all get to realize a few stark facts in the actual streets we live in:
1) only people on medicare/ medicaid get full care because its paid by the govt and people like me on a regular shrinking middle class salary - postpone basic blood tests to buy bread and gas
2) we have experienced the policies of the past few governments and politicians - so spare us the sermon - its time to start something new
3) and dont worry - the insurance companies will actually win out in this deal by getting more enrollees
4) stop this partisan BS - its really really harming us now
5) lack of education in this country is really harming us now
6) the degradation of a country begins with the erosion of the middle class
7) raising taxes is the only way to get out of this recession - tax breaks have never created jobs because corporations don't pay taxes
Regards
Reply to this commentLinkReport AbuseTom
not enough to have a repeal obamacare mantra. rebs must demonstrate in language average people can comprehend advantages of personal choice and sanctity of dr - patient relationship absent in obamacare
Reply to this commentLinkReport AbuseI agree with Chris Vu. But Obamacare isn't going to be repealed or replaced until January 2013 at the earliest (although a few more votes in the Senate to put the 23 Democrats up for reelection on the spot would be good). Seems like the GOP nominee in 2012 will have to have some kind of replacement plan.
Reply to this commentLinkReport AbuseToo few GOP Members of Congress know anything about health care and the few that talk seen to be struck in the mold that the private sector and MSA are the solution to everything. The legislative and regulatory complexity of health care does not go away with just the repeal of Obamacare and any chance of success with repeal depends on having a viable alternative. The alternative should include some major insurance reform and nationwide competition. It probably should include a broad employer mandate achieved thru incentives. Prescription drugs should have more competition and no advertising would would save half a $trillion in 10 years alone. Medicaid might just as well be turned back to the State to fully run with block grants and the issues and approaches differ greatly by region. Medicare on the other hand has a low overhead is reasonably well run but only covers 80% of cost and required at Insurance .Suppliment Maybe the percentage might change over time or the age of eligibility but total transfer to the private sector doesn't do it for me
Reply to this commentLinkReport AbuseThe real problem is that Republicans are all about helping out their billionaire buddies, at the expense of the rest of us. They aren't about offering real alternatives to these problems. They don't want to reform health care, because insurance companies are making a killing. We need to have serious restrictions on how much insurance companies can raise premiums from year to year, co-pays and deductibles. They also need to enact transparency in health care pricing. If you sought out a service from a business and their was hidden fees, would you want to become a return customer? Of course not! It's poor business practice. Problem with all of these is that they are consumer protections, and insurance companies will fight tooth and nail to keep any consumer protections from being enacted. Do any of you actually believe that if the Republicans provided an alternative that it wouldn't be highly influenced by special interests?
Reply to this commentLinkReport AbuseThe real problem is that Republicans are all about helping out their billionaire buddies, at the expense of the rest of us. They aren't about offering real alternatives to these problems. They don't want to reform health care, because insurance companies are making a killing. We need to have serious restrictions on how much insurance companies can raise premiums from year to year, co-pays and deductibles. They also need to enact transparency in health care pricing. If you sought out a service from a business and their was hidden fees, would you want to become a return customer? Of course not! It's poor business practice. Problem with all of these is that they are consumer protections, and insurance companies will fight tooth and nail to keep any consumer protections from being enacted. Do any of you actually believe that if the Republicans provided an alternative that it wouldn't be highly influenced by special interests?
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