For a long time, I’ve been arguing that the Republican Party has painted itself into a corner with regard to Obamacare. The linchpin of the law is the individual mandate and it is what was put forth by the Heritage Foundation and enacted in Romneycare. It was the great conservative healthcare idea that would save us from the dreaded single payer health insurance that liberals wanted. Now that conservatives have defined their very own healthcare plan as a Stalinist plot to rid America of freedom, they really don’t have anything to offer.
Ezra Klein wrote an excellent article last week on the history of this, Newt Gingrich Explains How the GOP’s Obamacare Tactics Backfired. He noted that when the Democrats proposed conservative healthcare reform, the Republicans could have gone before the TV cameras and laughed and said, “At long last, they agree that the conservative policy is the best!” Instead, they redefined the political center so that their once conservative plan was an extreme left wing conspiracy.
So where does that leave the Republican Party? Aaron Carroll at The Incidental Economist wrote a series of articles that answer exactly this question. The first one is aptly named, Backed Into a Corner. It is about the conservative fascination with the healthcare systems in Switzerland and Singapore. This all comes out of ignorance of these systems and the conservatives’ desperate desire to find some system—Any system!—that works and is more conservative than Obamacare. He wrote:
That’s how you get conservatives advocating for “SwissCare,” while ignoring that Switzerland has an individual mandate, more regulations, price fixing, and lower caps on out of pocket spending.
That’s how you get conservatives advocating for Singapore’s health care system without any real understanding of it. Singapore’s system has massive subsidies for nursing homes, rehabilitation care, and home-based care. It requires mandatory savings—36% of wages spread over various accounts. The government also provides a basic level of care that’s heavily, heavily subsidized. And here’s the kicker—it relies on tons of government intervention in the market to keep costs down. They use centrally planned and fixed budgets, they control the acquisition of new technology, they regulate the number of students and physicians, they use purchasing power to buy drugs more cheaply, they have an employer mandate for foreign workers,and they have a national EHR. They’re also not the most open society in the world.
Here’s the thing. I bet you could find lots of liberal wonks, and lots of Democrats, who would be fine with much of the above. You want Swisscare? Great. You want Singapore? OK. The problem is that’s not what’s offered. It’s Swisscare, but without a mandate. Guess what? That’s doesn’t work—that’s why Swisscare has a mandate! They suggest Singapore, but without the mandatory savings, public hospitals, and government management. That doesn’t work—that’s why Singapore has those aspects.
But it gets more bizarre. Just two days later, Carroll was back with the news that, “Singapore announced that however much government is involved, it’s not nearly enough.” And then he listed all the ways that Singapore is making their system more like Obamacare, even with all the other socialist aspects of their system that we do not have.
So what are the conservatives to do? Well, it isn’t like anything has really changed. It’s just the supposed conservative wonks who keep looking to other countries for systems that might work and be conservative. But let’s not forget that even among these people, we know from experience that if the Democrats went along with a new plan, these supposed policy thinkers would turn against these ideas. So Avik Roy can enjoy his reputation as a Reasonable Republican and be booked on All In, but anyone who is paying attention knows that he and those like him are at best apologists for whatever crazy idea the Republicans are currently focused on.
The week before last, I went after Lanhee Chen who claimed at Republicans had all kinds of great ideas for healthcare reform. Of course, none of his ideas would address the healthcare crisis in this county. In fact, they were mostly just a laundry list of conservative wishes that have only minor relationship to healthcare. Then, just 5 days later, Karl Rove wrote his big OpEd in the Wall Street Journal that listed the same exact policies, Republicans Do Have Ideas for Health Care. It had the offensive subtitle, “But liberals don’t like to admit it because the GOP would put patients, not government, in charge.”
Aaron Carroll again went to work and destroyed Rove’s list point by point, Karl Rove’s Health Care “Ideas.” The truth is that some of the ideas would actually make the problem worse. But whether or not the ideas work is beside the point. The point for Rove, Chen, Roy, and the whole Republican establishment is to counter the widely held opinion that the Republican Party just doesn’t care. But the truth is that if you push even these establishment types (Not to mention the extremists!) you will soon learn that they think we don’t need to worry about the uninsured because they can just go to the emergency room.
The modern conservative movement puts liberals in a very difficult position. We can’t just let their baseless claims go unchecked. But by attacking them, we provide the movement with a certain level of legitimacy. And it is wholly unearned. With healthcare, the situation outside of politics is clear: there is a big problem and something must be done. But Republicans don’t want to do anything. So what should be their strategy? Clearly: obstruct and claim that they have great ideas that the opposition won’t listen to. This is exactly what the Republican Party is doing. I think that demonstrates that they don’t want different policies from the Democrats; they want no policies.