Six years ago I knew what the Conservative-Republican ideas were:
- Give people skin in the game via high deductibles and high copays.
- Push people out of tax-subsidized employer-sponsored insurance into individual-marketplace exchanges as fast as possible.
- Encourage insurers to shrink their networks in order to bargain more aggressively with health-care providers.
- Cut Medicare.
Ezra Klein reviews the troops:
Republicans are having to come to terms with the fact that Obamacare will not conveniently collapse… have zeroed in on two things that people really will hate about insurance under Obamacare: The high deductibles and the limited networks…. What’s confusing about this line of attack is that high-deductible health-care plans–more commonly known as “health savings accounts”–were, before Obamacare, a core tenet of Republican health-care policy thinking. In fact, one of the major criticisms of Obamacare was that it would somehow kill those plans off…. When Republicans were forced to come up with alternatives for Obamacare, high-deductible plans were core to those proposals. “Conservatives have suggested deregulating Obamacare’s exchanges to make it easier to provide policies with high deductibles,” wrote Ramesh Ponnuru. One of those conservatives was right-wing darling Dr. Ben Carson….
Now that those high deductibles are here, Republicans have decided that they are, if anything, too high. Just one more broken promise….
Insurers entering the competitive health marketplaces are tightening their networks in order to cut costs and improve quality. It’s worked: Premiums in the marketplaces are far lower than was expected when Obamacare passed. This, too, is a success for a longtime conservative health-policy idea…. They were in Paul Ryan’s 2009 health-care proposal. They’re the basis of the GOP’s plan for Medicare reform…. “Narrow networks are not some cruel attempt to limit patient choice foisted upon us by the insurance industry,” write economists David Dranove and Craig Garthwaite. “Instead, these plans may provide our best opportunity for harnessing market forces to lower prices.”
But Republicans don’t seem pleased to see their ideas in action….
I asked some of the GOP’s most influential health-care voices about the tension between the criticisms Republicans are launching against Obamacare and their longstanding commitment to these ideas. One common response I got was that it’s fair to criticize President Obama’s broken promises even if the underlying policies are desirable. Project HOPE’s Gail Wilensky, for instance…. Another answer was that Republicans believe that Obamacare is giving policies they otherwise like a bad name… Avik Roy…. The problem, in other words, isn’t the higher deductibles and the tighter networks–it’s all the other stuff. In that case, it’s weird Republicans are focusing on the higher deductibles and tighter networks. The GOP’s problem is that the “other stuff Obamacare does to the insurance market” is wildly popular….
We’ll see whether Obamacare withstands the onslaught. But either way, once the assault is over, what kind of health policy will Republicans be left with? How can they propose anything that will cancel plans or raise deductibles or tighten networks? How can they propose anything at all?