ObamaCare for less
Matt Miller writes in The Post that he'd advocate repeal of ObamaCare if Republicans could come up with a plan that could cover 30 million uninsured Americans for less. I would suggest that's the wrong question. But in any event, Republicans have come up with such plans, and they no doubt will come up with others.
As for the flaws in the question, the first problem is the size of the "uninsured" population and whether we should be covering every person without insurance. A 20-something who'd rather buy a car than health-care insurance is required to buy health insurance (with the help of government subsidies) or face a fine under ObamaCare. Republicans think that's not how government should be spending taxpayers' money.
Moreover, there is more than a little over-counting in the 30 million uninsured figure. Phil Klein highlighted a couple years ago: "[T]he 2003 BlueCross BlueShield study determined that 8.2 million Americans are actually without coverage for the long haul, because they are too poor to purchase health care but earn too much to qualify for government assistance." Now, Megan McArdle is out with a devasting analysis, observing that there is strong likelihood that "we just passed a massive new health care entitlement in large part based on appeals to the plight of people who do not exist -- at least, not in anything like the numbers that we were told."
The second problem is how ObamaCare defines "insurance." Miller has previously argued that ObamaCare is a "defined contribution" plan. But is that right? ObamaCare defines exactly what type of health-care insurance "counts," and it has loaded up the minimum level of acceptable coverage with many costly items that not every consumer needs or wants. A true defined contribution plan is what Republicans have suggested -- a lump sum that allows individuals to purchase whatever insurance they want.
The third problem is that Miller, like most liberals, shows undue reverence for Congressional Budget Office scoring. James Capretta of the Ethics and Public Policy Center (and formerly an assistant director of the White House Office of Management and Budget) e-mails, "CBO is not at all friendly to market-based reforms." In other words, the sorts of cost-saving measures that Republicans have and will propose are likely to be undervalued or ignored entirely by CBO. Moreover, as Charles Krauthammer argues, CBO's figures on ObamaCare are based on false premises topped off with accounting "flimflammery." So why should CBO be the end-all-and-be-all in health-care plan evaluation?
But now we get to the plans. There are conservative plans that would provide for very large number of Americans to gain coverage at much less cost. Take the plan put out by Sen. John McCain (R-Ariz.) in 2008 that would have covered 27.5 million people at an annual cost of $287 billion. Sen. Jim DeMint's plan would have covered over 22 million people. There was also the Patients' Choice Plan put forth by Rep. Paul Ryan (R-Wisc.), Sen. Tom Coburn (R-Okla.) and others.
However, Miller's point is well taken: Republicans have talked a lot about "repeal." They will have to talk in more detail about the "replace" part. It is good to know that Miller will be in their corner if they do their homework. They need to clearly explain one or more plans that help to keep costs down and extend a reasonable level of coverage to tens of millions of Americans.
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