Earlier this week, Ross Douthat wrote about the debate that has been going on between Ezra Klein and Ben Domenech about whether or not conservatives actually have an alternative to Obamacare. Douthat thus gave us, The Republican Health Policy Trainwreck. But don’t let the title fool you, it is basically an apologia for the Republicans. His basic point is: “I think the answer is pretty straightforward: a conservative alternative or alternatives, yes; an alternative that Republican lawmakers are ready to vote for, no.”
He claims there is a big rift between conservative policy wonks and conservative politicians. He points to a number of conservative policies that the think tanks have come up with but which the Republican Party will have none of. Oh well, Douthat is a conservative, so I guess he is allowed a little delusion. The fact is that this isn’t even close. As you may remember, the individual mandate (Obamacare) was a conservative policy idea. Once it became politically viable, all the conservatives turned against it—not just the politicians. Thus, I can’t see the new conservative ideas as anything other than a cover for being against any extant policies.
Most of the article is about how Eric Cantor tried to take discretionary money and give it to one of the under-funded high risk pools. And he couldn’t even get the other Republicans to go along with that, even though it was really just a way to make it harder for the government to help poor people. And that’s my point: even the “reasonable” conservatives are only willing to do something on healthcare if it can be used to more generally hurt government services. Regardless, these ideas are not alternatives to Obamacare, they are just Trojan horses meant to destroy the program. (BTW: the supposed alternatives are either changes around the edges of the pre-Obamacare system or ridiculous notations that “the free market” will fix everything. If that were the case, then we wouldn’t be stuck with Obamacare.)
Recently, a study was released that looked at outcomes of a sample of people who qualified for Medicaid in Oregon. Because it was underfunded, those who got it were picked by lottery. In the two years of the study, they found that healthcare outcomes weren’t significantly different for the two groups but financial outcomes were. There are a couple of things to note here. Those on Medicaid received far better preventive treatment. The effects of that treatment will generally be seen over a longer time period than two years. What’s more, the financial aspect is huge. I currently owe almost $200,000 for a hospital stay I had five years ago when I was employed with a company that promised health insurance next month for three years. Anyway, to my mind, the study shows that Medicaid is at minimum a great thing.
But not all people think that. Aaron Carroll and Austin Frakt over at The Incidental Economist report on how conservatives are greeting the study:
This is what the “reasonable conservatives” like Ross Douthat don’t want to admit: their allies (and maybe they themselves) don’t want healthcare reform. As always, they think that helping the poor is bad because: (1) it disincentivizes the poor to work; and (2) the poor are undeserving because they are morally inferior. And, to use a rhetorical trick that I learned from Matt Yglesias, that’s fine. If they want to hate poor people for being poor they should go for it. What they shouldn’t do is pretend that they are just trying to better serve the poor with all their great ideas for healthcare reform.