The Republican Party has been on the verge of coalescing around its alternative health-care-reform plan since the health-care debate began seven years ago. The latest almost-there, just-have-to-cross-some-i’s-and-dot-some-t’s update came two months ago, when the New York Times reported, “if the Republican nominee does not provide an alternative to the Affordable Care Act — something Republicans have failed to do since it passed in 2010 — Mr. Ryan intends to do so.” But guess what? Ryan’s plan once again will not be an actual plan at all, but a series of generalized ideas that sound good in the abstract yet fail to specify how they would work. “House Republicans’ ObamaCare replacement plan will not include specific dollar figures on some of its core provisions, and will instead be more of a broad outline, according to lobbyists and aides,” reports Peter Sullivan.
Even though Republicans keep promising over and over that they’re just about to unveil a serious plan to replace Obamacare, and the news media keeps reporting these promises at face value, it never happens. There’s a reason for that. The Republican health-care stance combines rhetorical opposition to all of the cruel features of the old health-care system with denunciations of every practical measure in Obamacare required to fix them. The unspecified alternative allows them to promise that nobody will suffer from lack of access to insurance, but without committing to any sacrifices needed to make this happen. As Sullivan reports, Ryan’s plan “will not include specific dollar amounts on how large the tax credit would be, nor will it note which employer health insurance plans would be subject to taxation.” In other words, there will be no way to determine how it will be paid for or what kind of benefit it would fund.
There is no magic plan, no way to conjure dollars out of thin air, that could satisfy the political conditions Republicans require. Conservatives have plenty of health-care ideas, of course. But all of those ideas impose widespread, unpopular fiscal pain on tens of millions of people. Conservative ideas would throw tens of millions of people off their insurance, raise taxes for many more people, make basic medical care unaffordable to people who can now access it, or possibly all those things. Associating themselves with a measurable plan would expose them to devastating political attacks, so they won’t do it.
If there was a real Republican plan with real numbers, it would politically implode. The numbers aren’t just details to be worked out. The numbers are the whole problem.