Conservative philosophy—from Burke to Hayek—suggests that comprehensive plans are a fatal conceit; the world is too complex to plan. The notion that Republicans could magically “fix” the largest sector of the world’s largest economy is dubious, at best.
Sure, every other liberal democracy in the world uses more government intervention to deliver health care to everyone for considerably less money. But “philosophy” tells us that this is unpossible! Cf. Edumund Burke on the French Revolution.
All of this would be funny, except that “our alternative is tort reform and deregulating to make sure health insurers are as scrupulous as credit card companies” is also the de facto and sometimes explicit position of Republican lawmakers:
The history of the development of the Republican alternative to Obamacare since the beginning of the health-care debate, in 2009, has been an endless loop of loud promises that a full plan will be announced soon, followed by quiet admissions that it will not. Seventeen days ago, Donald Trump promised a vote to repeal the law “probably some time next week” with a vote for a replacement “very quickly or simultaneously, very shortly thereafter.” At a meeting in Philadelphia yesterday, Trump and his House Republican allies produced no agreement on a plan. If there is a consensus, it is that there will be no replacement plan at all.
Representative Greg Walden, a key leader of the House Republican efforts on health care, tells Julie Rovner, “There’s no single fix. There’s no single plan.” Representative Marsha Blackburn touted bills to limit medical malpractice lawsuits and to allow the sale of state-regulated insurance across state lines. Neither of these proposals would have any significant impact on insurance coverage. If Obamacare is repealed, this would leave the individual-health-insurance market a smoldering crater.
Not that this surprising, but there is never going to be a Republican replacement for the ACA. The only real question is whether they give up and leave it more or less in place, or blow it all up. The all-or-nothing stakes make it more likely that the ACA can be saved, but also make the consequences of losing horrible. We know Paul Ryan would strip health insurance from tens of millions of people without losing a second’s sleep, so this comes down to marginal votes in the Senate (and whether stripping tens of millions of people of their health insurance is important enough to McConnell to be worth eliminating the legislative filibuster over.) But Senate Democrats need to understand the state of play. No compromise is possible; no somewhat-worse GOP alternative to the ACA is passing. Either stop repeal, or make the GOP fully own it — those are the only choices.