The Corner

Replacing Obamacare

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.

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