The Republican Health-Care Plan Has Everything Except an Actual Plan

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Paul Ryan Speaks At The House Administration Committee Legislative Data And Transparency Conference
The dog ate Paul Ryan's health-care numbers.Photo: Mark Wilson/2016 Getty Images

Because the health-care system that existed before Obamacare was a moral and fiscal disaster — exposing tens of millions of Americans to cruel deprivation even while paradoxically costing far more per capita than any other such system in the world — designing a hypothetical program to improve upon it is simple. You’d almost have to try to design a plan that isn’t better. The hard part is allocating sacrifice and getting people to accept disruption. That is why passing Obamacare into law, which required making changes acceptable to tens of millions of patients, doctors, nurses, insurers, and other stakeholders, was such a political triumph. And it is why the House Republican “plan” to replace Obamacare, published Wednesday, is not a plan at all.

What Republicans have released is, at best, a plan to create a plan later. They would repeal the Affordable Care Act and replace it with some cheaper and more loosely regulated alternative. There would be tax credits, though it doesn’t say how much, and it would be funded by limiting the tax deduction for employer-sponsored insurance, though it doesn’t specify that either.

Because it would strip away protections for patients with expensive medical conditions, the Republican plan offers a compensation: high-risk pools that sell insurance only to people with very expensive medical needs. Such pools already exist, and they work extremely badly, in large part because providing insurance to people with very high medical expenses is, well, expensive. The main trick to making such a mechanism work is funding it. But enacting new taxes to pay for social benefits for the socially vulnerable is not exactly a passion for the Republican Party or Paul Ryan. The current plan is no exception, providing a fraction of the required funds to make high-risk pools functional. Even Tom Miller of the conservative American Enterprise Institute admits, “That’s not enough money.”

The vagueness protects Republicans from identifying the people who would pay more, or get less care, under their plan. A House leadership aide, asked by the Washington Post how the plan would change the uninsured rate, replied, “You’re getting to the dynamic effect of the plan and we can’t answer that until the committees start to legislate.”

But that is not a matter of details. That’s the whole problem. It’s like the Jerry Seinfeld riff about the car-rental company that takes the reservation but does not hold the reservation:

Outlining a health-care plan without numbers is easy. You need to actually produce a system that covers people’s medical care, or admit that you are going to take away what they have. At the end of the day, there’s either a car or there isn’t. Seven years after Congress started debating health-care reform, House Republicans are still a car-rental agency with no car.