There Is No Way Of Reforming Health Care While Preserving Everyone’s Insurance

This is a very important point:

The employer-based health-insurance system is much more popular than the individual market. It’s also much more redistributive. The 25-year-old male in the loading dock has to pay the same premiums as the diabetic 60-year-old in accounting. Is this injustice an important part of the political discourse? How often do you hear people complain about it?

Every iteration of an alternative conservative health-care proposal would impose far more disruption on the status quo than would Obamacare. Most conservative plans involve drastically curtailing the tax deduction for employer-based insurance. That would create cancellation notices for many times the number of people currently seeing them. Even the more modest plans to scale back Obama’s regulation of the individual market would run the GOP into a political minefield. Which regulations do they want to strip away? Discrimination against people with preexisting conditions? Discrimination against potentially pregnant women? Mental-health parity? Every single one of those changes creates millions of angry potential victims.

This is exactly why the actual Republican Party health-care plan is not repeal and replace, but repeal and cackle. Republicans are on strong ground exploiting fear of change. They have understood perfectly well that they must avoid having to defend a different set of changes to the status quo. They have kept their various replace ideas safely to the side for exactly that reason.

I’d also note that there’s nothing in the status quo ante that guarantees that you could keep your existing insurance. You could, for example, lose your job.

And this is also crucial. A lot of anecdotes about “cancelled insurance” aren’t actually going to pan out.