Paul Ryan

Republicans Have a Vision For Health Policy, and They'll Be Happy to Tell You About It Just as Soon as They Figure Out What It Is


In the 2010 election, Republicans framed their response to the passage of President Obama's health care overhaul around two words: repeal and replace. When Republicans retook the House, they immediately staged a mostly symbolic vote to repeal the health law. But replacement has proven a far more difficult task. It's not just the threat of the presidential veto, or the fact that Republicans don't have the votes in the Senate for either a repeal or replacement measure. It's that Republicans still don't know what exactly they want to replace ObamaCare with.

In January, Republican legislators promised that they would have a replacement measure ready by this summer. The idea was to have legislation standing by should the Supreme Court strike down all or part of the health law.

By March, however, the message had changed slightly, and the promise scaled back: Senate Minority Leader Mitch McConnell would only commit to eventual incremental reformism — a series of small steps that would eventually add up to a replacement.

Even that proved a little too ambitious. By this month, Republicans in Congress made it fairly clear to The Hill that no replacement bill would be forthcoming. Staffers had been putting together options for months, but weren't able to create consensus. Getting Republican legislators to agree on any sort of clear legislative alternative apparently proved too difficult.

Instead of substitute legislation, reports The Washington Examiner's Philip Klein, House Budget Committee Chairman Paul Ryan says that Republicans will merely present a "vision" for the kind of health reform they'd prefer. "We do feel obligated to articulate our vision for replace," Rep. Ryan told The Examiner. I'm sure that Ryan, who has arguably been the GOP's most consistent and effective policy entrepreneur for at least the last five years, really does feel that obligation.

Nevertheless, it's telling that two years ObamaCare, the party is still waffling indecisively on exactly what to do about health policy. Part of the reason that Democrats have been relatively successful at passing major health policy legislation is that they have spent a lot of time working on it. But with a few exceptions, that's just not the case for Republicans. Obama was able to campaign effectively on health reform and pass the 2010 law in large part because Republicans had ceded the issue to Democrats following the defeat of President Bill Clinton's attempted health care overhaul in the early 1990s. Democrats, meanwhile, regrouped, and created a aggressive policy infrastructure devoted to exploring both the politics and policy aspects of health care. With the passage of ObamaCare, it finally paid off.

Republicans, meanwhile, have taken the law's passage and subsequent unpopularity mostly as an opportunity for short-term political gain rather than as a call to begin laying out and making the case for their preferred structural reforms. It's nice to see that Ryan is promising to release a set of health care priorities and principles, but it should have happened years ago. And the fact that it didn't is part of the reason why Democrats were able to pass ObamaCare in the first place. As with so many policy areas, Republicans know what they're against, but not what they're for. 

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  1. You have to vote for them to find out what’s in their mind grapes.

    1. u mean in the insurance cos minds

      1. Yep. B/c the insurance cos must be furious about laws forcing people to purchase their products.

  2. Republicans, meanwhile, have taken the law’s passage and subsequent unpopularity mostly as an opportunity for short-term political gain rather than as an opportunity to commit political suicide by laying out and making the case for their preferred structural reforms.

    Fixed it for you.

    1. There are a few things that seem totally uncontroversial that would likely help a lot:
      – Allow purchasing health care across state lines.
      – Allow for high-deductible, catastrophic insurance without all of the mandated extras.
      – Allow individuals to spend pre-tax dollars on health expenses like businesses (or don’t allow either to do it).

      Why can’t the Republicans get behind something like this? Who are the forces that would prevent it? Would those options really be political suicide?

      1. Fair enough. The answer is that they are craven and stupid.

      2. Oh, yeah, do for health insurance what we did for the credit card companies. Let the state legislature of Alabama or Mississippi set the national standard for health insurance. How perfectly “uncontroversial!”

        Thaaaannnk Yooooooo Sooooomuch Nick!

        1. You aren’t “letting” them do anything. If they’re climate is more competitive than other states’ climates’, that’s the states fault, not the credit card companies’ fault.

          IOW, you are blindingly retarded.

          And what exactly is broken about the credit card market? I hear about 1% of the complaints about VISA I hear about UnitedHealthCare.

          1. Why are you talking to Mary Stack, Randian?

            1. oh really?! Honestly!

              I had no idea.

              1. Yup. This one is definitely her, but it’s a safe bet to assume all trolls are her anyway.

              2. You also have no idea about the difference between “their” and “they’re.”

                Being called “retarded” by you is a badge of honor of the highest order.

                You are so far beneath contempt you have to look straight up to see the soles of Gallagher’s shoes.

                I have no idea who this “Mary Stack” is, but based on the hatred she engenders in this hooting pack of mouth-breathers, she must be something wonderful.

                1. Shut up Mary. Everyone knows who you are. You might have been smart enough to use a different name. But your whole point is to get attention. God you are sick and pathetic.

                  1. John, I’d like to make you bet your life on that. And then I’d like to collect the bet.

                    1. Why, Mary Stack of Fort Worth, Texas, is that a thinly veiled death threat against John?

                    2. (N.B.: a wish is not a threat)

        2. Registration at Last!,
          Well, there are no shortage of companies offering me credit cards with competitive interest rates and other nice perks. In fact, the Reason credit card ad is showing on the side of this page right now. Contrast that with health insurance where in most markets there are only a couple of providers who all have premiums that increase by 10% per year. I think you’re right — let’s do to health insurance what has been to credit cards. It sounds a lot better than the status quo.

  3. Back during the Bush II years, I owned a business and was a member of NFIB. Our membership lobbied for a number of health care reforms (allowing purchase of insurance across state lines, for example). But even when Team Red had both congress and the presidency, they did absolutely nothing.

    So I’m not surprised.

  4. Howsabout converting Medicare to a voucher system, reducing CMS staff by, say, 7/8ths, with the task of overseeing the Medicare plans offered by private insurers, rather than their current task of micromanaging health care providers and payers.

    Was that so hard?

    1. Didn’t Ryan propose exactly that in 2010?

      1. Maybe. I don’t recall. They don’t seem to be doing it now, though.

        1. His original plan was to make medicare into a voucher program. And he still advocates for that as far as I know.

          1. YES!!!

            “Voucherize Medicare.”

            I want to see this on every Mitt Romney billboard in 2012.

            1. Go fuck yourself Mary. And I see your involuntary commitment is over.

              1. John,

                Haven’t you been watching her videos? 😉

                I’ll bet she will be on here in a minute explaining how her server logs “prove” you’ve watched her videos hundreds of times, a thousand times today, in fact.

              2. See supra, the wager I’d like.

        2. Call it “Medicare Freedom of Choice”: you, the beneficiary, get to choose what benefits you want!

  5. Allow people to buy catastrophic health insurance without buying all the extra stuff. Allow purchase of insurance across state lines. Means-test the heck out of some of these programs.

    Then nobly sacrifice your political career for the sake of statesmanship. So there’s that.

    1. Allow people to buy catastrophic health insurance without buying all the extra stuff.

      People aren’t smart enough to know their own needs. I mean, a man might opt out of prenatal care or breast cancer screenings!

  6. Really? The name game for alt text? Take a vacation Pete and recoup some of that creativity of yours.

    1. Vacation is still a week away, sadly.

  7. I’d eliminate the tax breaks for employer-sponsored coverage, cut out out the vast majority of the essential benefits stuff, and see what happens.

    1. You would drastically increase everyone’s tax bill. That would be the first thing that would happen.

      1. how? the goal is to break the bond between employment and coverage.

        1. Everyone’s taxable income would increase by the value of the health insurance coverage. That is a lot of money and a big tax bill.

          Your goal may be to break the bond between employment and coverage but in doing so you will Steve Smith most of the country.

          And if you break that bond, great. Guess what, everyone also loses out on the benefits of buying in large groups and sharing the risk.

          1. Most people have access to more durable and often bigger groups than employers to become insured through.

            The problem is that the work connection has so completely dominated group insurance that all other forms of mutual aid have disappeared.

            1. Most people have access to more durable and often bigger groups than employers to become insured through.

              What groups would those be? And if said groups exist, why haven’t people who are between jobs or work for employers who don’t provide insurance used them?

              That is just nonsense Issaac. There is nothing inherently wrong with tying health insurance to employment. Most people have a job. And employers enable people to pool their negotiating power.

              1. Churches. Communities. Civic Groups.

                And if said groups exist, why haven’t people who are between jobs or work for employers who don’t provide insurance used them?

                Because they’ve been crowded out by the tax code and don’t exist anymore.

                1. Professional and trade associations, too.

              2. only b/c the employer is limiting my choice of plan. granted, under ACA i don’t have much of a choice anyway ..

              3. Fraternal organizations.

                There’s a reason why they were so big in the period between 1870 – 1960 and went into decline after LBJ launched his great society.

                1. It had nothing to do with them having no appeal to the younger generation and society changing. Nope. It was all about the evil LBJ.

                  Jesus Tarran, have you lost your mind?

                  1. Well, yes John, community-based organizations do die on the vine when the government crowds them out. It’s good you recognize that.

                    IIRC, you’re a Christian, right? So you have a built-in organization that could offer you insurance right there. You’re also a veteran, so there’s another community that could privately offer you insurance.

                    Hell, your damn condo board could offer it to you. There is no reason why the customer in 99% of insurance cases should be your employer instead of you. It’s a messed up system, and government messed it up. Your hostility to this is baffling, because I thought you were an organic-community small-town loving conservative.

                    1. Fraternal organizations were a primary method that people got social services such as welfare, emergency funds, insurance and medical care.

                      The progressives sought to curtail their power throughout the early 20th century (for one example, see here).

                      You can see some vestigial signs of this to this day. When I was studying to take the exams to become a health insurance producer (aka a salesman) there were questions on how, according to federal law, fraternal organizations had to select their officers.

                      Their inability to attract young people had much to do with the fact that the benefits of membership had been severely reduced by regulation and by law and the rise of the welfare state during the ~50 year period between the end of WW-1 and the first Nixon admin.

                2. And insurance became a employment benefit during World War II Tarran, long before the fraternal orders started to die.

                  And even if it were true, fuck that. I don’t have to join the damned Elks to get health insurance.

                  1. No, but you should be free to do that. Or even better to join the Elks, and gain access to the doctor they keep on retainer to treat members on an emergency basis.

                  2. And insurance became a employment benefit during World War II Tarran, long before the fraternal orders started to die.

                    I wouldn’t call 15 – 20 years a long time in this context.

              4. Um, *Most* people having a job is only barely true. Labor force engagement rate has been under 70% for a while now and has dropped as low as 64%.

                Further of that 64% a significant margin is made up of either the self employed or those employed by small businesses with fewer than 50 employees so while *Most* people have a job at best a slim majority and more likely a minority actually benefits from getting their health insurance through their employer in any way.

          2. So make employer purchased health insurance nondeductible and simultaneously lower the corporate income tax rate so the net change is approximately revenue neutral. I’m sure the bureaucrat number crunchers could get it at least in the right ballpark.

        2. Because the conversion from employment benefits to cash would increase your tax burden.

          1. fair points. I suppose you could shift the break from employer to the individual for the purpose of buying coverage. that might be a backdoor mandate.

            but getting the employer out of the equation, i think, is needed if we’re going to reform the system.

          2. So cut tax rates at the same time.

            I would much rather see a tax system with fewer deductions and lower rates than the other way around.

            The idea that employer furnished insurance is a tax free benefit while private insurance has to be purchased with after tax dollars is simply bizarre.

            1. So cut tax rates at the same time.

              HAHAHAHA You are a funny guy Issac.

              1. I think it would sell well. You explain it puts employer versus employee purchased insurance on the same tax footing, thereby fostering a more competitive health insurance market, which ACTUALLY drives down costs, and is revenue neutral.

                Do you really think voters won’t buy that?

                1. Unfortunately, what the voters will actually buy is the guy who says he’ll pay their doctors and hospital bills for them.

              2. Yeah, John, ’cause no one ever cut tax rates before.

      2. Not really, the average employer contribution for health coverage is somewhere around $12,000 a year for family coverage and less than half that for individual coverage. This would increase the tax bill by anywhere from $0, for those who currently have no tax liability to maybe as much as $6000 for someone in the top tax bracket with a very generous health care package as well. On average I would guess it would result in somewhere around a 10% increase in taxes owed.

        However this could be offset by making medical insurance premiums tax deductibile

  8. Jindal has a health care plan lying around somewhere. You should go talk to him.

  9. If i remember correctly, I believe the “Most Interesting Man in the Senate” has a proposal that would give the geezers the same health care options that our Congresscritters get.

  10. The only thing we know for sure is that it will be just as expensive, will funnel billions of dollars to special interest, and won’t cover birth control or abortion.

  11. well, the sharks have been jumped by all parties involved (except Gary Johnson).
    Schumer at it again

    1. And Orrin Hatch demonstrates why he deserves to be punched in the mouth*:

      Senator Orrin Hatch of Utah, the top Republican on the Finance Committee, said he opposed people giving up their citizenship to avoid paying taxes.
      “It always bothers me when somebody renounces his citizenship in the greatest country on Earth just to save money, save taxes,” Hatch said in an interview. “I was really upset at Eduardo Saverin for doing that, and there are others who are doing it too.”

      Cry me a river you fucking douchebag.

      * Hey, he started it by bodily threatening me

      1. God Hatch is an asshole. I so hope Utah gets rid of that bastard.

        1. But John you’re just a Republican shill 😉

      2. Dear Sen. Hatch,

        You taxing people who want to leave your country takes you down a few notches on the whole greatest country in the world thing. Also the fact that more people want to leave should tell you something ya jackhole.

  12. Republicans, meanwhile, have taken the law’s passage and subsequent unpopularity mostly as an opportunity for short-term political gain rather than as a call to begin laying out and making the case for their preferred structural reforms.

    Rubbish, you are begging the question

    I am a Republican and I did not want the system changed, except, perhaps, at the margins. Therefore, I do not need to present a plan for structural reforms.

    This does not mean I was completely happy with the pre-Obamacare system, just that I believe that any changes directed from congress will result in a even worse situation for my family.

    1. I am with “Truculent” here. How hard is it to say that the state of affairs before Obamacare after Obamacare?

      Repeal it first. There is no reason we have to accept this “anchoring” position of “what’s the alternative?” I don’t know what the alternative is, but the ex-ante status quo is a damn sight better anyway, so let’s start there.

      This is like asking “What’s your alternative to the War on Terror?” How about “No War on Terror”?

      1. I think the burden would be on you to defend per capita healthcare costs double the rest of the civilized world as not a problem that needs solving.

        1. Tony,

          The american people had that problem solved long ago. The U.S. government saw it as an emergency requiring correction.

          How Government Solved the Health Care Crisis: Medical Insurance that Worked ? Until Government “Fixed” It

          Today, we are constantly being told, the United States faces a health care crisis. Medical costs are too high, and health insurance is out of reach of the poor. The cause of this crisis is never made very clear, but the cure is obvious to nearly everybody: government must step in to solve the problem.

          Eighty years ago, Americans were also told that their nation was facing a health care crisis. Then, however, the complaint was that medical costs were too low, and that health insurance was too accessible. But in that era, too, government stepped forward to solve the problem. And boy, did it solve it!

    2. So what you are saying is you like big government republicanism? Looks like you’re one of the enablers of this short term thinking.

        1. I did not want the system changed, except, perhaps, at the margins. Therefore, I do not need to present a plan for structural reforms.

          This system before was a bloated government controlled mess, most recently expanded my a TEAM RED government.

  13. The removal of State Line barriers to insurance competition seems to me to be an easy line in the sand to draw if anyone in Washington wants to make a stand.

    They need to start with the stuff that will have an immediate financial impact that consumer can benefit from, and then work on the rest of the details. Fostering greater market competition would deliver that.

    1. A full assertion of federal power over interstate commerce would be a good start in all areas. No, I don’t mean using the clause to force people do shit. I mean using the clause as it was intended to get rid of state government restraints on trade.

      Why the hell should I have to go to a state licensed middle man to buy a car? Why can’t I just buy it off the internet and have it delivered to my house like any other product?



    Breitbart News has obtained a promotional booklet produced in 1991 by Barack Obama’s then-literary agency, Acton Dystel, which touts Obama as “born in Kenya and raised in Indonesia and Hawaii.”

    The booklet, which was distributed to “business colleagues” in the publishing industry, includes a brief biography of Obama among the biographies of eighty-nine other authors represented by Acton Dystel.

    I have never been a birther. But how does this happen?

    1. I have never been a birther. But how does this happen?

      95% of WTF situations are explained by the fact that people are lazy and stupid, and the fact that people apply considerable energy and intelligence to accomplishing their lazy and stupid ends.

      1. So they just happened to mistakenly get his place of birth wrong? That is kind of big deal in a biography.
        Unlikely. Maybe Obama falsely claimed to have been born in Kenya to up his leftist street creed. That is much more likely and believable. Or maybe he really was born in Kenya and was telling the truth.

        1. He checked that box… then un-checked it later.

        2. Maybe Obama falsely claimed to have been born in Kenya to up his leftist street creed

          It could be that.

          Or maybe they sexed up his bio and he didn’t care/notice and didn’t make them fix it.

      2. The same way Elizabeth Warren was a *Minority* Professor.

        People say stupid shit to get special benefits all the time, it just never occurs to them that there is a paper trail left behind should they ever become politically powerful enough to matter.

        Whether Obama ever told that publisher he was born in Kenya and Raised in Indonesia isn’t really relevant, he would have certainly been aware of the claim and failed to correct it because for whatever reason at the time he percieved those facts to be to his benefit never imagining he’d one day actually be running for President when such facts would be inconvienent.

    2. Why did they use a pic of Treyvon Martin?

      1. Maybe Trayvon was actually Obama’s illegitimate son from an affair that he had ~18 years ago. Anyone know if Trayvon’s mom was living in Chicago at the time?

        I keed, I keed!

        1. No, keep going…see, the Administration hired Zimmerman to Vince Foster Trayvon Martin to keep the truth from coming out.

          1. I tip my tin-foil hat to your superior conspiracy mongering skills.

          2. Go post that on Free Republic. I bet you get followers within the hour.

    3. Let’s hope this story gets some legs.

      Personally, I think he lied about where we was born for street cred. Wouldn’t be the first time, either, as I seem to recall he was classified as a foreign student at his first college.

      The idea that he didn’t look at this little bio is absurd, and his claim that he had no idea that it existed is an obvious lie.

      1. It is kind of a big deal to get something, even an article published, especially for the first time. You read what they write about you.

        1. An insecure narcissist like Obama? There’s no way he didn’t know.

          He might have been to lazy to get it fixed, or maybe he LIHOP, but he had to have known.

  15. Does anyone have any proof that selling across state lines and allowing bare bones plans will actually save consumers money? As far as I know, both have been tried, and both haven;t produced any real savings.

    From the AJC :

    A new law that allows Georgians to buy health insurance plans approved by other states was envisioned as free-market solution that would lower prices and increase choices.
    So far, the law has failed to produce results: Not a single insurer is offering a policy under the new law.

    “Nobody has even asked to be approved to sell across state lines,” Georgia Insurance Commissioner Ralph Hudgens said. “We’re dumbfounded. We are absolutely dumbfounded.

    Many conservative policymakers say a more open insurance market free from individual state regulations could add competition to the private market for health plans, used mostly by people who can’t get insurance at work. But the experience so far in Georgia has some wondering whether the concept is the answer after all.

    1. Continuing :

      Hudgens, a conservative Republican who strongly supports free-market ideas, said he expected policies sold in states such as Alabama, which have fewer requirements for health plans, to be offered in Georgia after enactment of the law.

      “I’m really surprised because it was such a bumper sticker issue by Republicans saying if we could get across state line selling, we could reduce the cost of health care,” he said.


      Bill Custer, a health care expert at Georgia State University, said some states have experimented with offering bare-bones plans in the past and haven’t observed much success.

      “The cost savings weren’t sufficient to justify the fear from consumers that they would be without some coverage they may need,” he said.
      Under the new law, health plans approved under the rules of other states could be sold in Georgia, even if they don’t meet Georgia requirements.

      In theory, the law would allow a Georgia-registered insurer to scour the nation and find a bare-bones plan to offer private market customers in Georgia ? presumably at a cheaper price.

      Because the law still requires Georgia licensing and oversight, it does not create a completely free-market scenario. It essentially just allows insurers licensed in Georgia to get around the state’s benefit mandates.

    2. The answer is right there in the article:

      1) All the health insurance companies would have to be licensed in Georgia – that imposes a pretty hefty cost.

      2) The health insurance industry (as well as the employer benefits industry) are all paralyzed by uncertainty regarding what’s going to happen with Obama Care.

      My guess is that no company is willing to invest the time and money to get permission to do business in Georgia, and the ones already doing business in GA aren’t going to undercut their own local products with cheaper out of state ones. Moreover, based on personal experience talking with consultants working for Paychex, the paralysis due to regulatory uncertainty is absolutely real and pervasive.

      1. That licensing requirement is a killer.

        If you’re already licensed, then you have a suite of plans out there that are GA specific. I guarantee you a barebones plan will have a lower margin. Why would you cannibalize your existing customer base with a lower-margin plan?

        Being licensed as an insurer is expensive. Nobody is going to take that on just to sell a low-cost, low-margin plan.

  16. Here’s a starting suggestion for them.

    1. Instead of requiring insurers to cover pre-existing conditions, forbid them from stopping coverage for “post-existing” conditions. Make it so they can’t drop coverage after someone gets sick and make them liable for long-term care for chronic problems if the problem began when the patient was insured with them.

    2. Remove the tax deduction for employer-based insurance and replace it with a tax-deduction for individually purchased insurance.

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