Damned If You Do

At Bloomberg View Megan McArdle phrases the alternatives that Republicans face about the Affordable Care Act slightly differently but arrives at the same place:

You do not fix a concrete eyesore in stages. You either knock it down, or you leave it where it is and learn to live with its flaws. If Republicans want to actually do a radical renovation of our nation’s health policy architecture, then they should get a reasonable estimate of the costs, grit their teeth, and go ahead and actually build something sound, and enduring, while demolishing substantial portions of the ugly and unsustainable mess we currently have.

If Republicans cannot get up the will to bear those costs, then they should do nothing, and start preparing their rebuilding strategy while they wait for the flaws in Obamacare’s structure to bring down the individual market on its own. Neither strategy is painless, because the ossified mistakes of earlier policy making have taken all the cheap and attractive options off the table. But either is better — for America, and for the Republican Party — than setting new mistakes in stone.

For Democrats the alternatives are slightly different. They must choose which they value more: President Obama’s legacy or the welfare of the American people. And their own.

10 comments… add one
  • steve

    “Neither strategy is painless, because the ossified mistakes of earlier policy making have taken all the cheap and attractive options off the table.”

    No such options existed. There were better and worse alternatives, but they all had trade offs. If your goal was just to cut costs, then you had cheap alternatives.

    Steve

  • walt moffett

    It is going to have to crash and burn before either party recognizes there is a problem that they can solve.

  • Guarneri

    “If your goal was just to cut costs, then you had cheap alternatives.”

    And if your goal was to set up a system that would send your cornerstone exchange structures into death spirals……….you could hardly have done better. First, do no harm.

  • Scott O

    Guarneri, you’re right, Trump Care seems designed to ensure that a death spiral occurs.

  • michael reynolds

    Republicans refuse to get an estimate of the costs because then they’ll have to admit they haven’t the first tiny clue what to do. They never did.

    This. . .

    For Democrats the alternatives are slightly different. They must choose which they value more: President Obama’s legacy or the welfare of the American people. And their own.

    . . . is a particularly false equivalency. We tried, they never did. We would have accepted changes to improve the system, they have refused. It is painfully obvious that their only motivations were racist spite and the nasty greed that characterize Republicans.

    I get a nearly $7,000 tax cut and a few more of the working poor will die. That’s the GOP plan.

  • Modulo Myself

    I like how McArdle requests that Republicans come up with a real plan as if she lives on a distant planet with only the news as her guide and isn’t speaking at conferences about policy. It’s a giveaway about what a scam right-wing/libertarian ideology is. If I were the Kochs I would be asking exactly what I spent these millions on–a plan that gets owned and dunked on in a week? And someone like McArdle who has probably ingested 100K of Koch-purchased appetizers alone in the past eight years is like ‘The GOP should come up with a plan that works.’

    The only cheap alternative in any of this would be to replace the entire GOP with their younger but no less smarmy interns.

    It’s just a total disgrace. And trying to pawn this off on Democrats is appalling. The idea that we’re just going to wait until Obamacare destroys the individual market is equally void.

  • Gray Shambler

    Every comment here is pointing fingers, you can do better.

  • Modulo Myself

    Check that: if you want to blame the Democrats for anything blame them for not demanding single payer in January 2009 with the same idiotic but effective repetitiveness of the average Republican. They should be doing that now: single payer will solve all of your problems and we’ll make the oligarchs and elitists pay for it.

  • Gustopher

    For Democrats the alternatives are slightly different. They must choose which they value more: President Obama’s legacy or the welfare of the American people. And their own.

    Obamacare, after a few years of performing better than the CBO expectations, seems to have matched CBO expectations — so after a few years of lower than expected cost increases, it had a year where there were higher cost increases.

    Is it a crisis, or a correction? It’s a little hard to tell.

    What is pretty easy to tell, however, is that the Republican plan, which keeps much of the same structure as Obamacare but is way less generous, is going to result in fewer people covered — it is objectively worse, without attempting to fix any of the problems with healthcare costs rising faster than inflation.

  • Jeff J

    The American public are the ones damned. Obamacare created heightened expectations of comprehensive health care coverage for the masses. Republicans are left to rein back those expectations in line with the realities of their fiscal conservatism while seeming sensitive to the fates of those with limited resources who need health services. Under the present course, the ‘damned’ among us will pay more for less covered benefits and deminished access. The hardest equations involve balancing social values with the cost of supporting those values. So far with healthcare, the solution seems beyond the grasp of our leaders.

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