The Politics of Conservative Health Reform

by Ramesh Ponnuru

My recent article on congressional Republicans’ misguided complacency about Obamacare drew a response from Jonathan Chait. I thought this passage deserved further comment:

Republicans have wisely decided to attack Obamacare without committing themselves to an alternative because the alternative would be easy to attack. Ponnuru, for instance, suggests changing the tax code and stripping regulations to create “a market in which almost everyone would be able to purchase relatively cheap, renewable insurance policies that protected them from the risk of catastrophic health expenses.” Telling tens of millions of Americans they’ll lose their insurance that covers basic medical expenses and get bare-bones policies with thousands of dollars in deductibles is not a winning play (emphasis in original).

First, I don’t think the alternative I outlined would be as easy to attack as the Republicans’ current lack of an alternative is. Second, I am pretty sure the reasons congressional Republicans have not corporately embraced a robust alternative to Obamacare are the ones I outlined in my article, and do not include any fear that a shift toward catastrophic coverage would be unpopular. That’s just not, in my experience, the way congressional Republicans think.

Third, and most important, I don’t think it’s right to say that moving to the freer market I advocate would involve an unpopular reduction in most people’s benefits. Almost everyone would be able to buy catastrophic-only coverage, but many people, perhaps most, would want more and would be able to get it. That’s why directly after the words Chait quoted I wrote, “(although most people would be able, and would probably opt, to purchase more extensive coverage than that).” I should probably not have put that in parentheses. The main reason one might see the average insurance policy covering a smaller share of medical expenses is that people might choose to pocket the savings from less extensive policies. The politics of such a reform seem at the very least manageable.