Republican Health Care Mess

The Republicans have announced that they are gearing up to deal with the post-Obamacare era when, and if, the Supreme Court rules that the mandate is unconstitutional.

Recall that the mandate is a part of the overall legislation that makes it mandatory to sign up for health care. This is the element of the law that most vexes the right wingers and libertarians. They see it as a massive intrusion of individual rights. After all, they argue, if someone wants to avoid paying for health care until they need it that’s their right. Apparently free loading is sacred to libertarians.

It is far from creation that the Supreme Court will strike down the mandate, but just in case the GOP has started to crank up its response.

Or not.

The problem is that there are parts of the law that are very popular. Yes, people actually like Obamacare when it is explained properly and it is stripped of the tarnish of evil that the libertarians like to mask it with. This is, of course why the libertarians detest the law so much – the voters will want to keep it.

Back to the GOP.

They are in a pickle. They’d like to get rid of the entire thing and throw health care onto the wide open market. But getting rid of those popular bits in an election year could cause a lot of trouble. The radicals and revolutionaries of the libertarian army are scared of democracy: they’r prefer it that voters aren’t given a chance to decide what the people want or get. At least not this year.

Worse for the GOP: if they don’t roll back the law it will start to stick. If Obama wins in November – a close call at the moment – their next opportunity will be after the 2016 election by which time this popular bits of the law will have become even more popular. So the window within which the libertarians can get rid of Obamacare is narrow.

The problem is that they don’t have any alternatives.

None.

Except for a motley rag-bag of old legislative initiatives like allowing small business to band together to share insurance policies. All of this bits and pieces are, by and large, part of the law. Don’t forget that Obamacare is modeled on Republican policies originating in the network of right wing think tanks during the anti-Clinton reform struggle. The biggest addition that Obama included in his legislation was the mandate which is designed to do what none of the GOP ideas do: reduce costs. It is the mandate that reduces policy costs because it adds to the insurable population a vast swathe of young healthy people. This is something that no other plan does, and is the only reliable way to cut costs.

Which is why the GOP is stuck.

They would love to keep the popular parts of the law so they don’t get attacked at the polls. But those parts are costly. Health care costs would rise, not fall. The entire goal of reining in costs would not be achieved.

Whoops.

So a day after proudly stepping up an announcing that they are right ready to fill the breach were the mandate struck down, the Republicans are facing away furiously. They’re reduced to using the infamous Paul Ryan and his obfuscating tactics to hide their lack of preparation.

Ryan evades responsibility with his usual pro-market magic reference. “We believe in patient-centered and market-based medicine.” As if that’s a novel plan.

Note to Paul Ryan: apart from Medicare we have a market based system. It’s expensive, ineffective, delivers bad care, produces rotten results, and leaves tens of millions of people uninsured. It sucks. Oh. And by the way. Market based health care can never, ever, work. There is no way for the essential elements of a market to come to bear in health care. People cannot change doctors easily, they don’t have sufficient information to make informed choices – do you know enough to argue with your doctor about the treatment being prescribed? and there’s that problem of free-loading.

No.

The Republicans have no plan,

As long as they try to deliver health care through market magic they will solve nothing and, eventually, drive voters into the arms of Obamacare.

And using Paul Ryan to lead the charge is just plain dumb. Because he is.