Pethokoukis

Obamacare is, apparently, declining to implode

HealthCare.gov

HealthCare.gov

Jim Capretta and Ramesh Ponnuru, in separate pieces, offer some gentle truth telling about Obamacare. It’s not going to implode of its own inherent economic faults anytime soon. Ponnuru: “The law will continue to be implemented, with the administration making whatever revisions it thinks necessary.”

And even if Republicans gain control of the White House and Congress, there are limitations to what a GOP president would do. For instance, maybe President Rand Paul would decide to disallow the federal health exchange from paying premium credits to 10 million Americans. As Capretta puts it, “A reversal of this kind would be politically tumultuous, to put it mildly.” Adds Ponnuru: “It seems unlikely that Congress would pass legislation to strip coverage from millions of people.”

And that’s probably even with a reasonable replacement plan all lined up. Just a few years after one massive, convulsive change, Republican are going to offer another massive, convulsive change? What’s more, while center-right policymakers are cooking up various reform plans, one ingredient needs to be in all of them: universal coverage as an explicit policy goal. As Avik Roy wrote earlier this year:

No conservative politicians oppose universal public education; instead, we champion reforms that improve the quality of public education that poor Americans receive. Ensuring that every American has access to quality health coverage is a legitimate goal of public policy, and it can be done in a way that expands freedom and reduces the burden on American taxpayers.

There is no “repeal” in the Roy plan. Broadly he would (a) deregulate the exchanges, (b) gradually raise the Medicare age, effectively funneling more people into the exchanges, and (c) put acute-care Medicaid patients into the exchanges, “while returning its long-term care and disabled populations fully back to the states, free of federal interference.” Whatever the flaws in the Roy plan, it has a big advantage in that it works off the status quo, rather than attempting to scrap the status quo. (See: path dependence.)

Follow James Pethokoukis on Twitter at @JimPethokoukis, and AEIdeas at @AEIdeas.

10 thoughts on “Obamacare is, apparently, declining to implode

  1. Nice to see conservatives acknowledging reality and coming to a commitment to provide rational healthcare for everyone. EVERY advanced country in the world makes this work. It’s not like we’re inventing the wheel here.

    There needs to be discussion about what ‘returning long term care back to the states’ means, but it’s a step in the right direction.

    • If by make it work you mean lower survival for heart attack , cancer and stroke, even worse management of high blood pressure in Canada, land of ‘free’ health care, long waits to receive needed care, lack of access to treatments like dialysis, then yes they ‘make it work’.

      • Cherry picking. Canada has better healthcare than we do, as measured by life expectancy. Your comment is worthless.

        As to waiting…how long do you wait if you have no health insurance like the US?

        answer: for the rest of your (short) life.

        Nice system we got. Expensive, poor value and restricted access wit

        • Life expectancy is a bogus measure of health care philosophy because it is influenced by so many other factors that health care commissars can’t control and couldn’t care less about, such as lifestyle, migration, race, and even marginal things like war and weather disasters. You LIE — through your rotten, snaggle teeth — and so implicitly does AEI when you both say or imply that I have “waited all my short life” for health care without insurance. I have NEVER had insurance in my whole life, yet have ALWAYS been treated at American hospitals promptly and without debilitating delays. I paid in installments after the fact at a rate I could afford, and when sometimes I became unemployed the debt was written off. Hospitals are tax-exempt charities — or they used to be before ObominationCare — and this means they have always given free care to those who really needed it. AEI and other pseudo-conservative, neocon Trojan horses within the Republican Party and conservative movement are subtly shilling for Socialism, and that is fully consistent with their Trotskyist origins and utter lack of ideological transparency.

        • Work?

          How about something that is way better, something American that employs free markets instead of government control?

          I like to think we could have done a lot better than mediocre.

        • Judgement is different than reality – by what basis do you consider Canada’s system better – the metrics that are available disprove your opinion.

      • Cherry picking. Canada has better healthcare than we do, as measured by life expectancy. Your comment is worthless.

        As to waiting…how long do you wait if you have no health insurance like the US?

        answer: for the rest of your (short) life.

        Nice system we got. Expensive, poor value and restricted access with long wait times.

  2. Obamacare will not implode without alternatives that would marginalize it.

    Think of this: Why can I pay a tax and do nothing at all to protect others from me, yet not buy a health insurance contract that does something substantially more than nothing in protecting others, so long as I also pay the tax? On this States need to step up and make available non “qualified” real insurance at very low prices, stripped of all the mandated garbage. Add to this simply freezing the mandate tax at $95 or 1% would keep the alternate contract choice the best one for most people, marginalizing Obamacare without its repeal.

    Andrew Schlafly, attorney for the Association of American Physicians and Surgeons, told me he knows of nothing in the Affordable Care Act that would prevent states from taking this bold move for its citizens.

  3. Essentially all these Republican “bargaining” solutions involve kicking away some of the three legs of the stool that make viable Obamacare or any program that sets out do what Obamacare does and consequently would take away the coverage of millions, bring back a lot of unattractive conditions, and increase the deficit. This the reality which a number of health policy experts who aren’t partisans like Roy or Ponnoru are pointing out. At some point conservatives and Republicans are going to have to come to terms with this however uncomfortable.

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