Repeal and Replace?

Tyler Cowen offered this observation about the Republicans in regards to health care:

The Republican Party, by the way, still doesn’t have a coherent alternative for health care reform, nor do they seem willing to embrace many of the better parts of ACA, such as (partially) deregulating dentistry or the Medicare Advisory Board.  Romney seems to want to replace the mandate with more expensive tax credits.  Furthermore, I believe that many Republican legislators would rather run against an unpopular Obamacare than to have to craft an actual, legislate-able alternative.

I think he’s is correct- to a point.  The GOP hasn’t really put forward an alternative to Obamacare which has led a lot of folks to make the same charge that Cowen makes.  But I think what is forgotten in all of this is that there really isn’t an incentive for Republicans to offer an alternative.

Back in 2009-10 former Utah Senator Robert Bennett worked with Oregon Democratic Senator Ron Wyden on a healthcare alternative to the Obama plan.  Bennett’s reward for coming up with a plan?  He lost a shot at another term in Congress.

Most of the bloggers that I follow tend to think that policy is something that should be above politics.  I wish it were so, but it isn’t.  Policy is in many cases driven by politics and that’s what is going on here with the GOP and health reform.  It’s not that there aren’t credible ideas coming from conservatives; it’s that in this 50/50 political climate that we live in there is no incentive to really push for credible reform.  The GOP has won in the recent pass with no real plans to change health care.  There is no cost to them for NOT providing an alternative plan.  There IS a lot of reward for running against the plan and talking about repealing the Affordable Care Act.  It comes down to a cost-benefit analysis: it makes more sense to be against the President’s plan than it does to come up with another idea.

There is another reason that the GOP won’t come up with a replacement: the media and the Democrats.  When Republicans do come forward with ideas to reform some aspect of health care, it is usually viewed unfavorably by both groups (ie: Paul Ryan’s Medicare plan is viewed as wanting to kill little old ladies).

I believe the GOP won’t put forth a serious idea until one of two things happen: the GOP coalition falls apart and they are cast in a permanent minority as they were from the 30s until the 90s; or a crisis of some kind is so severe that the normal rules of politics are suspended and their hand is forced.

None of this means that the Republicans should be excused for not coming up with a real plan.  But unless the political cost-benefit analysis changes, you are not going to see any GOP legislator champion comprehensive reform.

PS:  The Spring edition of National Affairs does have one idea for replacing Obamacare that people might want to take a look at.

One thought on “Repeal and Replace?

  1. Bruce R. Gilson

    I just looked at the National Journal article you mention. There is a lot that merits consideration there. It may not be an ideal approach, but it’s a good start.

    Reply

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