Should-Read: Craig Garthwaite: Why replacing Obamacare is so hard: It’s fundamentally conservative

Should-Read: Craig Garthwaite: Why replacing Obamacare is so hard: It’s fundamentally conservative: “As a life-long Republican… I’ve come to an answer that will be hard for many conservatives to swallow… https://www.washingtonpost.com/opinions/why-replacing-obamacare-is-so-hard-its-fundamentally-conservative/2017/07/10/c5d64634-6351-11e7-84a1-a26b75ad39fe_story.html

…Passing an Obamacare replacement is difficult because the existing system is fundamentally a collection of moderately conservative policies…. There simply isn’t much room to the political right of Obamacare for a policy that covers as many people with high-quality insurance. Furthermore, many have realized that there isn’t much political will for a bill that covers meaningfully fewer people or that places low-income individuals in insurance plans with cost-sharing elements they can’t afford….

Before I am drummed out of the party, it’s important that we consider our history…. Even Ronald Reagan saw a role for the government to provide quality health insurance for those who could not otherwise afford access…. The Republican Party was… a party that at its core supported a limited, well-run and efficient government. This fact can be seen in the structure of the social insurance policies we’ve historically supported… welfare reform and the earned-income tax credit… the expanded use of government contractors and outsourcing rather than an ever-growing leviathan… Medicare Part D, supporting Medicare Advantage and advocating premium support in Medicare. Each of these policies involves government intervention where the private market failed, but in a way that focuses on the diligent and effective use of market-based incentives and, where possible, private firms.

This history makes it clear: Obamacare is broadly an extension of traditional Republican beliefs…. Private firms provide health insurance in a free, but appropriately regulated, market…. Economics simply does not allow us to deny the underlying fact that these stable health insurance markets require regulatory guardrails. Furthermore, these Obamacare regulations all work together…. The regulation guaranteeing insurance access for those with preexisting conditions… [is] popular… [but] comes with the necessity of… market interventions such as the individual mandate and sufficiently generous tax subsidies to prevent a death spiral….

Unfortunately, these marketplace realities run afoul of the Republican Party’s newly developed preternatural love for completely unfettered markets—a love that is simply incompatible with reality and our party’s history. Quite simply, addressing adverse selection in health policy doesn’t mean you are surrendering to the long arm of government intervention any more than having the government enforce property rights or contracts is the first step on the slow march to socialism. It simply means we recognize that at times the conditions for healthy markets are missing and must be provided….

The inability to solve the big problems facing our great nation will be the beginning of the end of the [Republican] party.

July 28, 2017

AUTHORS:

Brad DeLong
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