Health Care

Republicans Didn't Lack a Plan to Replace Obamacare. They Lacked a Unified Theory.

The GOP never quite figured out how to think about broad health care goals.


As Republicans move towards a vote on a bill to rewrite Obamacare later today, it's worth looking back at why their last attempt at a vote, in March, crashed and burned at the last minute.

In a piece for Reason's print edition, I argue that the GOP's problem isn't a lack of a plan, it's a lack of a unified theory, a way of thinking about what health policy goals the party should favor, and what sort of process it should use to achieve those goals.

Here's an excerpt from the piece:

There has never been a shortage of GOP substitutes for Obamacare, from think tank white papers to congressional committee frameworks to fully drafted bills. But in the seven years that congressional Republicans spent promising to repeal and replace President Obama's health care law, none ever moved beyond the development phase, because what Republicans lacked wasn't a plan. It was a theory.

After the Affordable Care Act (ACA) passed, when Republican legislators were asked what sort of health system they preferred, most would say something about lowering costs, increasing affordability, and improving access. Some might criticize Obamacare for covering too few people, as Senate Majority Leader Mitch McConnell did in January. "What you need to understand is that there are 25 million Americans who aren't covered now," he said on CBS News. "If the idea behind Obamacare was to get everyone covered, that's one of the many failures."

But improved affordability and accessibility is an outcome, not a system. Republicans almost never took the time to describe the basic mechanics of how their preferred health care system might work. As a result, when the GOP took control of both Congress and the White House this year and the time came to draw up an actual plan to repeal and replace the ACA, it struggled to get out of the gate. Proposals were repeatedly altered and delayed. After the House repeal bill was released in March, it was met with an immediate chorus of criticism—with the loudest voices coming from the right.

Read the whole thing.

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  1. Why the actual fuck are they even bothering. It is beyond embarrassing at this point. No one on Capitol Hill actually wants to undo Obamacare, we get it now. Enough with wasting everyone’s time. Go name some fucking post offices.

    1. Like I’ve said for a while, the Republicans actually like the law. They just hate that they didn’t pass it. If they had Dems would be in power now and probably installing single payer as we speak.

  2. All sociopaths face free-rider problem in trying to come up with consensus unified theory or ideological strategic plan. It’s a type of public good. Nature of the beast. No politician is willing to bear the costs when he’d be able to free ride after somebody else has done the work and taken the risks. That’s a big reason why we correlate political success with the powerful leaders, sociopaths more adept and vicious who can concentrate benefits and credibly commit to punish free riders. Looks like the current repube party is populated by risk-averse, unimaginative thugs.

  3. The best thing about Trump is that Republicans are finally showing their true colors. For decades they could pretend to be for free enterprise, for rolling back the size and scope of government, for at least wanting to cut taxes and spending. Those of us with eyes and ears knew that wasn’t true, but it did seem as if Republicans actually believed it.

    They aren’t even pretending any more.

    We don’t have a liberal and a conservative party any more. We have a socialist/entitlement party, and we have a corporatist/warfare party. And I’m not entirely sure which is which.

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