The health-care ruling has exposed a delicate dance within the Republican Party. Romney does not want to run on the health-care issue. To the extent that he wants to invoke the issue, it’s to flay Obama for having focused on it as a distraction from the economy, not as an ideological crusade against Big Government. But conservative activists want to be sure that, if Romney wins, he will commit his political capital to repealing the Affordable Care Act. Thus their current focus on demanding that Romney pledge to repeal the law (see Avik Roy, Keith Hennessey, Rich Lowry, and David Brooks, among many others).
The interesting thing about these conservatives' arguments is that they are all committed, to varying degrees, to upholding the pretense that the Republican Party really wants to impose a more technocratically sound version of health-care reform. To be sure, they insist they are advocating a vastly different philosophical vision centered around self-empowerment and free markets and other wonderful things. But all of them say, or imply, that they share the basic goals of the Affordable Care Act, which is to make coverage available to all Americans and to control cost inflation. So, for instance, Lowry argues, “The two central selling points of the law — insuring millions more people and keeping people with pre-existing conditions from getting locked out of insurance — can be addressed with policies that are cheaper and less disruptive (a tax credit for purchase of insurance and high-risk pools, respectively).”
I see two problems with this hopeful scenario, both fatal.
The first is that the mythical Republican reform plan is really hard to pass. Conservatives may think they have a cheaper way to fix the system, but it still costs money. And Republicans have never appropriated any money to cover the uninsured. Indeed, all their plans divert money that already exists to cover people who need health care for other purposes. Conservatives hopefully propose turning the health-care tax deduction into a more progressive tax credit. Great idea! Except the plans put forward by Romney and Paul Ryan plow the savings from eliminating that tax deduction back into lower tax rates. And it leaves no budgetary provision for high-risk pools or any other mechanism to subsidize coverage for the poor and sick.
Now, you could suppose that maybe this is all one giant oversight. Republicans failed to craft an alternative plan during the health-care debate, then voted to just straight repeal Obamacare with no replacement, then voted for a budget that just straight repeals Obamacare with no replacement, but when they have power, then they’ll really come up with a plan.
But where is the evidence that they have any desire to do so? Sunday, the two most powerful Republicans in Congress appeared on interview shows and were asked what they plan to do for the uninsured. Mitch McConnell hilariously danced and weaved, admitting that covering the uninsured is “not the issue”:
Paul Ryan, as he is apt to do, offered a much smoother take, couching his position in philosophical abstractions:
What — what Mrs. Kennedy and others were saying is this is new government-granted right. We disagree with the notion that our rights come from government, that the government can now grant us and define our rights.
Those are ours. Those come from nature and God, according to the Declaration of Independence, a huge difference in philosophy.
What this blather actually means is that he does not accept that the government has an obligation to ensure that all Americans have access to health care.
If Republicans really wanted to replace Obamacare with some more “market-friendly” alternative, then there’s a simple way they could go about it. They could promise to repeal the law only if they packaged the repeal with a replacement that did not increase the number of uninsured. But they’ll never do that, because the magic, cheaper free-market alternative does not exist, and the GOP has no interest in diverting resources to cover the poor and sick.
Hennessey, who lays out the most specific vision for repealing Obamacare, asserts, “Repeal and replacement should be separate legislative efforts.” This means, of course, that the actual plan is first to get rid of Obamacare, then pretend to work on a replacement before eventually discovering that it’s expensive and unpopular. Oh well. The only interesting question here on any level is why so many conservatives feel bound to pretend that the Republicans really are going to formulate some other plan to care for the poor and sick.