At the New York Times in an op-ed on health care reform J. D. Vance, author of Hillbilly Elegy, does a pretty fair job of enunciating the essential problem that Republicans have in “repealing and replacing” the Affordable Care Act or in reforming health care at all:
It is true, as Republicans argue, that health care costs too much. And it is also true that Obamacare has failed to take care of this problem. But if Republicans fail to accept some baseline provision of care, we’ll find ourselves mired in internal contradictions — arguing, for instance, that a bill that cuts subsidies for the poor somehow makes care more accessible. We’ll rail against the way the government has destroyed our health care market in one breath and resist the support offered to the poor and middle class to navigate this brokenness with the other. This is not conservative; it is incoherence masquerading as ideological purity.
Democrats who support maintaining the ACA face issues nearly a mirror image of that. They’re either indifferent to costs or believe without a great deal of support that the ACA will reduce health care costs and all will be well.
That’s if you believe, as I do, that the ACA is not a stalking horse for a single-payer system. I don’t think that policy creation in Washington works that way. I think that the ACA was created by putting together the largest grab bag of buzzwords that had been floating around the Democratic party leadership for some time that they could get enacted.
” I think that the ACA was created by putting together the largest grab bag of buzzwords that had been floating around the Democratic party leadership for some time that they could get enacted.”
It’s important to remember it was law written purely by the Senate and passed by the House without any significant amendment. There were only a few minor changes made in reconciliation because the Democrats lost the supermajority in the Senate. In short, the ACA never went through a normal legislative process.
It’s also important to remember that it is basically RomneyCare, which was implemented in Massachusetts, and was based on the Republican alternative to the Clinton healthcare plan — it’s not a collection of random buzzwords that we’re floating around Democratic leadership, it was largely designed by the Heritage Foundation.
Further, it depends on private insurance and goes through giant hoops to keep private insurance in the picture. If it’s a stalking horse for single payer, it’s a pretty poor stalking horse.
“was based on the Republican alternative to the Clinton healthcare plan ”
Actually, it wasn’t THE alternative to the Clinton healthcare plan, it was one of several alternatives and it never went anywhere after the bill was introduced. It never was debated or voted on in any committee or the full Senate. It’s provisions had significant opposition in the Republican party. It was never part of the GoP’s platform. Many parts of the bill were substantially different than the ACA (as was the Heritage Foundation proposal). Some of the base concepts had been around a long time (ie. how to structure a mandate to avoid adverse selection). And this was 1/4 century ago when both parties were very different. Also, there’s probably a reason Romneycare was enacted in a solid blue state and not a red state.
But other than all that and a few other details I’ve probably forgotten, the ACA was based on the GoP plan.
PS, sorry for the ranty comment.
Guaranteed issue, community rating, a little of this and a little of that, put it all together and it spells ACA. It might have started off as a conservative plan but those had become the prevailing Washington wisdom in Democratic circles a long time ago. If it was a Republican plan, what was a Democratic plan? IIRC nobody, Republican or Democrat, has introduced a single-player plan in Congress since the 1970s.
My impression was that (A) Obamacare was intended to reassure insurance companies that they could continue to operate and make a profit even while a national scheme of socialized medicine was imposed upon the population, (B) that this concession to capitalism was supposed to win the support of market-loving Republicans, and (C) that while the initial operation of the new Federal health system might be a bit rocky, with bipartisan support and the rapidly improving economy, tweaking the system to make improvements would be straightforward.
Part A worked. Mitch McConnell and friends killed B. Republican opposition and eight years of lackluster economy killed C.
Listening to Dr. Gruber explain it, it sounds like it could work. One big problem is that all the parts have to work as described. People need to get healthy. Poor people need to find a non-ER healthcare. Healthy people need to buy insurance, and the list goes on.
It seems like he actually intended it to work.
If this is the path to single-payer, it seems rather convoluted, but maybe, it is convoluted just enough to confuse Republicans.
Love how he doesn’t even try offer an answer as to what the fix might be. It’s just babbling through stale conservative doctrine that nobody can possibly believe. And in the end, ‘conservative health care is a land of contrasts’.
Let’s see. Mitt Romney was right about Russia, and he knew how to fix health care. President Obama was a naive fool regarding foreign policy, and he was an idiot regarding the health care system.
@jan, you have a lot of people who now agree with you.