Network News

X My Profile
View More Activity
Posted at 9:22 AM ET, 03/ 8/2011

The alternative to ObamaCare

By Jennifer Rubin

Ezra Klein builds a column around an entirely false premise:

It's put-up-or-shut-up time for Republicans. They managed to make it through the health-care debate without offering serious solutions of their own, and - perhaps more impressive - through the election by promising to tell us their solutions after they'd won. But the jig is up. They need a health-care plan - and quickly.

I have often wondered whether the left punditocracy really is unaware of the multiple GOP health-care reform plans or whether the "party of no ideas" is simply an ingrained talking point that requires no factual underpinning.

The Democrats and their media surrogates posit that the Republicans position on ObamaCare is "Repeal and relax." This allows them to advance the fiction that repeal of all the ObamaCare related taxes (with help from CBO accounting antics) would result in an increase in the deficit. But, of course, Republicans are demanding, "Repeal and replace."

In order to replace ObamaCare, Republicans would have to dispense with the existing legislation, something that won't happen until a Republican president is in the White House. But it isn't hard to figure out what the Republican substitute is -- one need only look at the plans advanced since 2008 by Republicans.

The Republican alternatives (including those put forth by House and Senate Republicans and then-presidential candidate John McCain) contain common features: Convert Medicare into a defined-contribution plan, block grant Medicaid, allow interstate sales of insurance, provide tax credits for purchase of individual insurance plans, enact real tort reform and expand health savings accounts.

A handy guide to "Replace with what?" was put out last December by James Capretta of the Ethics and Public Policy Center and Thomas Miller of the American Enterprise Institute. The report should be read in full, but the nub of it is this:

A more sustainable, market-based, and patient centered version of health reform must avoid the common problems of taxpayer support of health insurance through a defined benefits structure. Those problems, whether they arise in the traditional Medicare program, state Medicaid programs, or the tax exclusion for [employer sponsored health insurance], all point in the same direction. Taxpayer support for defined health benefits provides strong incentives for beneficiaries to spend more, not less (particularly on the margin), for health care services whose costs seemingly are paid largely with other people's money. As long as those defined health benefits are treated as open ended legal entitlements, they will continue to place mounting pressure on federal and state government budgets.

The authors call attention to the Roadmap for America by Rep. Paul Ryan (R-Wisc.):

[T]he Roadmap, Americans age fifty-five and younger would enter into a restructured Medicare program that paid fixed-dollar amounts to the cost of their health insurance. The tax exclusion for employer health care would be repealed and converted into fixed-dollar refundable tax credits for all households with someone under the age of sixty-five.39 And states would choose either to allow their Medicaid recipients (except those who are disabled or receiving long-term care assistance) to participate in the tax credit plan (augmented by additional generous low income assistance) or to use federal block-grant funding to restructure their Medicaid programs with greater flexibility. These reforms are central to achieving Ryan's budget objectives, as CBO confirmed in its initial cost estimates of the plan. Over the long run, the massive run-up in debt that would occur under current law would be avoided entirely, even as taxes remained at the historical percentage of the nation's economic output. But even these numbers do not fully capture the importance of what Ryan has proposed. . . . The Ryan Roadmap is thus not just a budget plan. It is also a plan to transform American health care. It is built on the fundamental principle that a consumer driven system, with appropriate government oversight, can deliver much better health at lower costs than we are getting today.

Whether the Republican 2012 presidential candidates will adopt the Roadmap or some variation thereon remains to be seen. But in the meantime liberals should stop pretending there is no alternative to the deeply flawed ObamaCare.

By Jennifer Rubin  | March 8, 2011; 9:22 AM ET
Categories:  Obamacare  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: The left wigs out about hearings on Islamic radicalization
Next: What about those budget talks?

Comments

You might want to learn how to conduct a search on your employer's web site. Klein addressed Ryan's plan over a year ago, link copied below. I wouldn't be surprised if he addressed it elsewhere, but I didn't feel obligated to do any more of your work for you.

http://www.washingtonpost.com/wp-dyn/content/article/2010/02/05/AR2010020504796.html?nav=emailpage

Posted by: oldabandonedbeachhouse | March 8, 2011 9:51 AM | Report abuse

"I have often wondered whether the left punditocracy really is unaware of the multiple GOP health-care reform plans or whether the "party of no ideas" is simply an ingrained talking point that requires no factual underpinning."

Ezra is actually quite smart-and the answer is that he is adept at spouting the "ingrained talking point" that his journalistic (Journolist), Democratic-party talking point comrades espouse. Ezra is talented at building columns around false premises.

His "point" is to challenge anyone to produce a "better" bill than the "Affordable Care Act"-a name that defines the term oxymoron.

Since the cost benefits the ACA backers refer to are largely fictionalized, no one (especially Democrat or Republican governors, for instance) can offer a "better" plan, by Ezra's definition.

And what other packages could keep the American Trial Lawyers Association and other feeders at the Democratic party trough happier?

Truth is a serious casualty in his presentations, IMO.

Posted by: Towson_Tiger | March 8, 2011 9:54 AM | Report abuse

But in the meantime liberals should stop pretending there is no alternative to the deeply flawed ObamaCare.
***********************************
There she goes again.
Rather than engage the argument being put forth by someone Jennifer disagrees with, she simply creates a straw man to argue against. Maybe I missed something, but I don't see where in his column Ezra argues there is "no alternative to Obamacare."

I think what Ezra actually was saying is that House Republicans have only put forward a plan to repeal Obamacare, but they have no plan legislatively ready to go to actually replace it.

Citing to plans put forward by John McCain in 2008, or Rep. Ryan's Roadmap is hardly a sign of Republicans offering an alternative, if they aren't actually being put forth legislatively for debate.

Posted by: mustangs79 | March 8, 2011 10:01 AM | Report abuse

Why don't we adopt the same health care system Israel has. What's wrong with IsraeliCare?

Posted by: member8 | March 8, 2011 10:04 AM | Report abuse

Why is Klein's piece labelled "Business" (and in the Business section) rather than "Opinion"?

Posted by: asudnik | March 8, 2011 10:14 AM | Report abuse

It's Ezra. The kid can't understand The Constitution.

His "point" is to challenge anyone to produce a "better" bill than the "Affordable Care Act"-a name that defines the term oxymoron.

How can he justify that? The Dems said they would go back and fix stuff. Don't forget, we had to pass it to find out what's in it. That statement alone suggests we can do better than that bill.

Like the $105b HHS funding over the next few years that Michelle Bachmann just pointed out that needs to be repealed.

------

We subsidize them militarily, frees up money for other purposes.

Posted by: gopthestupidparty | March 8, 2011 10:20 AM | Report abuse

"contain common features: Convert Medicare into a defined-contribution plan"

Once Medicare becomes a defined contribution plan,will I be able to "Optout" or will I be forced to participate?
Who will manage the new plan,Goldman Sachs?

Posted by: rcaruth | March 8, 2011 10:24 AM | Report abuse

I have been reading Ezra's health care posts for quite some time, and do not believe they can fairly be characterized as having as their premise that the Republicans have "no" health care plan. I believe his point - made repeatedly and quite plausibly, and certainly not rebutted here - has been that the Republicans have offered no plan which can CREDIBLY substitute for the PPACA. His further point has been that when several of the Republican ideas are given close scrutiny, it is clear that they involve tradeoffs that the American public will reject. His still further point has been that there has been a good deal of Republican hypocrisy in loudly criticizing aspects of the PPACA while simultaneously offering ideas that would have the same or greater impact as the provisions criticized.

Posted by: lynnh00 | March 8, 2011 10:24 AM | Report abuse

Member 8 - What is the medical malpractice law like in Israel? How much does the average Israeli doctor pay for medial malpractice insurance? How many Israeli lawyers specialize in medical malpractice law? Did any Iawyer in Israel get rich the way John Edwards did here?

Posted by: Inagua1 | March 8, 2011 10:26 AM | Report abuse

Jennifer, please don't waste anymore of your time or ours responding to the walking democtratic talking point Klein. All his columns are the same, a democratic talking point, bolstered by selective data from leftists economists or other so-called experts. Why the Post continues to destroy its brand name by featuring this guy as providing any objective analysis is beyond me.

Posted by: MrRealistic | March 8, 2011 10:28 AM | Report abuse

The left wants to maintain the impression that the GOP favors a burnt-earth approach to all things government: burn it down, spread salt, and walk away. They therefore use every opportunity to reinforce that notion to one extent or another. On the Sunday shows they’ll simply say that Republicans don’t have a plan, while during the week on cable the rants get shriller and nastier.

Healthcare is an incredibly personal issue where too many folks allow emotions to get in the way of a rational discussion. Now that ObamaCare is law, the left can merely say that there’s a plan in place without having to explain its operation and consequences. Describing alternate plans takes more than a sound bite or two, more than a sentence, even more than a paragraph or two. These longer discussion are usually punctuated by sniping from a leftist who has every incentive to disrupt the flow of information and confuse the listeners.

By the way, Paul Ryan is the master of clear, concise descriptions; few on the left want to face him in any one-on-one discussion because of that.

Has anybody noticed a limit to what the left will claim? Yesterday a commenter left this remark:

//I've known Republicans all my life and utter lack of concern for people in distress is to them the proudest part of being conservative. It permits them both to stand in judgment of their moral inferiors, whose bad life choices obviously caused them to become distressed, and inhabit the toughness of ignoring pleas for help, which only liberals are weak enough to fall for. (Unless those pleas come from Goldman, in which case they're smothered with federal bailout dollars))//

Even his last sentence is ludicrous given that Goldman Sachs gave far more to Obama and Democrats that it does to Republicans, but the writer has a meme to maintain and can't be bothered with the truth.

Posted by: SCMike1 | March 8, 2011 10:28 AM | Report abuse

Inagua1, I don't have the answers to those questions, but apparently they have a handle on costs, as they spend under 8% of GDP on health care and we spend 17% (and skyrocketing). I assume they achieve massive cost savings with single payer, eliminating hundred-million-a-year CEO's and bonuses, and insurance bureaucracy. I would assume that they have less malpractice costs there because the system is better regulated and less wild-west, but I really don't know.

I do know that were I in Israel and in need of treatment, I'd totally trust the health care delivery, and and half the percentage of GDP that we pay, it sounds like a bargain. (A super bargain considering that per capita GDP there is $29,500 to USA's 47,000-ish).

To me the difference looks like a Chrysler at 50 K compared to getting a BMW for 25.

Posted by: member8 | March 8, 2011 10:35 AM | Report abuse

has been that the Republicans have offered no plan which can CREDIBLY substitute for the PPACA.

Who defines "credibly?"

Just because 1 may not like how it may be done doesn't mean the plan might not be "credible."

Posted by: gopthestupidparty | March 8, 2011 10:38 AM | Report abuse

This is, the child, Ezra Klein flailing around trying to provoke something. The child is all about covering everyone, but nothing about the $1 trillion to do that and how we will pay for that when we are already running $1.5 trillion deficits. If the child had any moxie, he would come right out and admit he thinks another couple of hundred billion deficit each year is fine as long as "everybody" is covered regardless of any Constitutional barriers.

Mustang79 flits in and shows his complete ignorance of basic logic by claiming when Rubin points out the clear direction the Republican's would take, that is somehow a strawman. No, it is not a strawman. It is a direct response to the child. Mustang79 then creates his own strawman by claiming the child really meant he wanted proposed legislation right now. But, what is the point of that with a Democratic Senate and Obama as President. There is time enough to do that battle in 2012.

Posted by: RickCaird | March 8, 2011 10:45 AM | Report abuse

When Uncle Sam dictates minutae, that's when the mess and unintended consequences really begin.....

If they allow us to choose - imagine that, choice over our bodies! - a plan from 1 of the other 50 states, why would Uncle Sam be concerned w/the minutae of that specific plan since it was already acceptable to Uncle Sam for a long time?

IF someone in CT doesn't want to pay for her neighbor's toupee, why should she? I think that's CT coverage......

The consumer is happy, the insurance co is happy, the hospital may or may not be happy.....

it is clear that they involve tradeoffs that the American public will reject

I'm not so fond of the tradeoffs now.

Posted by: gopthestupidparty | March 8, 2011 10:46 AM | Report abuse

SCMike1, have a little mercy on me, baby. I am not surrounded by Republicans at Yale. I'm surrounded by red-state yahoos south of the Mason-Dixon, and they tend to put things a little less delicately. William F. Buckley's they aren't.

The fact is that Republicans and many Democrats were just fine with the way things were before passage of the Patient Protection and Affordable Care Act. "Repeal and Replace" in fact means "Repeal." Unfortunately for Republicans, they're going to have a tough time getting industry on board to help them repeal, because now the insurance companies have the government putting a gun to everyone's head to bring them in to the office and force them to buy private insurance. Republicans only offer insurance CEOs the freedom of returning the freeloaders to their freeloading.

There was plenty of argument in the interminable period when the act was being developed. The real people I heard talking about it - Republicans - did not simply repeat Luntz-focused talking points, they said what they really thought; that there wasn't enough health care to go around, and those who didn't have money should be thrown out in the street to die, and that it was probably a good thing because those people were fat and drank and smoked and were lazy and poor anyway. To them - these Republican, mostly senior-citizen voters, this is what they thought, this is what they communicated to their representatives. And a sanitized version of that minus all the meanness is what came out of opponents mouths on Fox News Sunday and elsewhere.

Posted by: member8 | March 8, 2011 10:47 AM | Report abuse

Jen,

There is one candidate that you wish to wish away, but who is not going away who will take up the Ryan Roadmap and perhaps even accelerate its implementation along with greater reduction in the size of government and return of power to the states and that's Sarah Palin.

Posted by: stevendufresne | March 8, 2011 10:51 AM | Report abuse

What did Ezra Klein do in life to warrant column inches or commentary? I understand that he lived off his parents for a few years as a student and a blogger, and then the Post hired him. I presume he has his own apartment now, and does his own grocery shopping. But what has he done, won, created, or earned, again?

Posted by: IowaHawkeye | March 8, 2011 10:52 AM | Report abuse

It permits them both to stand in judgment of their moral inferiors, whose bad life choices obviously caused them to become distressed,

Does he mean like smoking & tanning? Until the outcry became too great, the NHS didn't want to pay for some newer cancer treatments.....or if the subject actually had the audacity to pay for it themselves, they were denied their "free" care.

Posted by: gopthestupidparty | March 8, 2011 10:57 AM | Report abuse

I assume they achieve massive cost savings with single payer, eliminating hundred-million-a-year CEO's and bonuses


There R only 7 million people there, how many companies can there be? Scale has to be taken into account at some point.


Assume? U might want to check out Canada's single-payer - they had a really sweet deal there for decades, when they couldn't get treatment there, care to guess where they went to get it done then charged it back? And they only have 32 million now....

We were their medical escape valve, not including "the world" threatening to break medication patents if our pharma didn't sell it to them cheap.....

Posted by: gopthestupidparty | March 8, 2011 11:04 AM | Report abuse

Oh, so there are plenty of Republican plans, but they're just not "credible." I see. Whereas 2,000 pages of gibberish that nobody ever read, passed in the dead of night, on a party-line vote, without public support, is the very model of credibility. Why, it's as credible as Obama's plan to revitalize GM with the Chevy Volt -- which is now flying off the lots at the brisk pace of three a day, nationwide. You see? Central planning WORKS! It worked in the Soviet Union, and it will work here! How's that for credible?

By the way, "simply an ingrained talking point that requires no factual underpinning" is an accurate description of ANYthing the lefties say. Usually in a single word, since lefties have a short attention span. Shall we talk about "privatization"?

Posted by: Larry3435 | March 8, 2011 11:09 AM | Report abuse

gop... I'm not an expert on Canadian health care. I have however been up there more than 100 times for work, for recreation. I have a lot of friends there. I've asked pretty much all of them how their system works for them, and they seemed very happy with it. I admit though I was talking to ordinary people, and not rich folk who need facelifts or anything like that. But mostly my friends are middle class people with kids where both parents work. They reported being very happy with it, and express sympathy with us for the mess we've got down here.

One friend of mine up there works in banking, and it seems there was no financial crisis there, none of their banks needed bailing out, and everything was just fine while our system collapsed. Apparently they've got lots of bank regulation there. Sorry off-topic.

Posted by: member8 | March 8, 2011 11:19 AM | Report abuse

They reported being very happy with it, and express sympathy with us for the mess we've got down here.


And how many of them were under the mistaken impression that if one doesn't have health insurance, one doesn't get treatment?

Posted by: gopthestupidparty | March 8, 2011 11:22 AM | Report abuse

And how healthy were they?

Posted by: gopthestupidparty | March 8, 2011 11:23 AM | Report abuse

It's a shame that the Republicans do not control a house of Congress in which they could propose their revisions to the health care system and get CBO scoring and all of the things done which one does with serious legislation.

As it is we are apparently forced to rely on hand waving accounts of what would be done with no way to test whether conservatives actually support their ideas, what the likely results of their programs would be, etc.

But until the Republicans win a house of Congress I guess they do have the excuse to fall back on that they are not in a position to make their ideas concrete.

Posted by: beckerl | March 8, 2011 11:38 AM | Report abuse

On one hand, you have a blogger who gets into policy details. And on the other, a Paul Ryan fanzine contributor. Who to believe, who to believe.

Posted by: oldabandonedbeachhouse | March 8, 2011 11:51 AM | Report abuse

I envision a little Ezra Klein doll on the desks of the Dem leaders, and whenever they wish to inject liberal talking points into the mainstream media, they just pull the little string on the back of the doll and the real Ezra - voodoo like - cranks out another WaPo blog posting.

Posted by: coffeetime | March 8, 2011 12:16 PM | Report abuse

Larry3435 writes: "Why, it's as credible as Obama's plan to revitalize GM with the Chevy Volt -- which is now flying off the lots at the brisk pace of three a day, nationwide. You see? Central planning WORKS! It worked in the Soviet Union, and it will work here! How's that for credible?"

Larry, let me tell you the story of a car. Once upon a time, a highly advanced industrial nation decided its citizens needed cars. It thought out and created a set of specifications for what the car needed to do: be cheap, not have radiators that could freeze, get good mileage, have interchangeable parts that could easily and cheaply be replaced, including the motor.

The result of that central planning was the most successful car ever built in world history. It had a production run almost uninterrupted from 1938 to 2003, selling over 21 million units. It was "the longest-running and most-manufactured automobile of a single design platform anywhere in the world."

And it was NOT, repeat NOT a creation of the free market. It was a government car, which the free markets of the world ultimately embraced, quite enthusiastically.

http://en.wikipedia.org/wiki/Volkswagen_Beetle

So, just for a moment, maybe you should consider that a nation working towards a single goal on something can sometimes achieve great things.

Posted by: member8 | March 8, 2011 12:25 PM | Report abuse

"Why don't we adopt the same health care system Israel has. What's wrong with IsraeliCare?"

It's Israel's priorities. You see neo/non-cons want to go all socialist by helping out Libyans, Egyptians, Iraqis, Iranians,Georgians, Germans,Kuwaitis, etc., while Israel decided to go all socialist on their own citizens by providing universal health care.

Both tracks transfer wealth away from their respective citizens.

Posted by: mfray | March 8, 2011 1:12 PM | Report abuse

mfray, so the Israeli's are evil socialists who are transferring wealth away from their citizens through a socialized medicine scheme?

Do continue...

Posted by: member8 | March 8, 2011 1:30 PM | Report abuse

If I were a leftist politico, I would be embarrassed to send children out to fight my battles, children like Klein, who is the DC equivalent of the drugged-up 14 year-olds with AK's in the various African hellholes.

I really don't understand either his visibility or relevance. There are some tough-ass leftists with a resume, a point of view, and a library (i.e., they're old enough to have read something). Instead, The Ezra-Man.

Posted by: IowaHawkeye | March 8, 2011 2:12 PM | Report abuse

"mfray, so the Israeli's are evil socialists who are transferring wealth away from their citizens through a socialized medicine scheme?

Do continue..."

No, no, no - they're not evil socialists. They're doing what they feel is right for them.

They have every right to choose what they want to do with their tax dollars.

Posted by: mfray | March 8, 2011 3:33 PM | Report abuse

Well ... I can't really add all that much to the chaos being thrown around here relative to the details of the Affordable Care Act or the so called Republican alternative(s). I suppose if the GOP had a plan, they would have proposed legislation by now - assuming they were really serious about replacing the legislation. So where is the "replace" part of the plan?

What really struck me about a clear 20-25% of the comments posted here is they are simply wild insults at the author, Ezra Klein. "He's a child", "what's he ever done", "lived off his parents" and so on; I won't repeat them all here. I guess I might ask what exactly have these folks posting the attacks have ever done. And since when is an idea wrong because the source is young or old or a person with which you may not agree.

People posting this kind of attack undermine their own position (if they actually have one) by resorting to simple, childish name calling.

Posted by: ZiggyStd | March 8, 2011 5:03 PM | Report abuse

And to those folks that want to devalue the Canadian system, I say you really can't dispute that most Canadians believe their system to be better and more cost effective than any other in the world.

I do not dispute that the US has the best health care "delivery system" going with most advancements developed in the states. But this discussion is really about the "health insurance" system. There's no doubt that in the US for many years this part of the equation has been left to the health insurance industry, to the detriment of the insured.

Gee ... isn't it a surprise that Canada doesn't have a big debt problem and they didn't endure a financial crisis as others did. Things must be well managed north of our boarder.

Posted by: ZiggyStd | March 8, 2011 5:20 PM | Report abuse

Regarding the stability of Canada’s financial system while ours, er, went to poop:

They did not have a Community Reinvestment Program that activists could use to bludgeon banks into making loans to folks who would not otherwise qualify for them. While Canadians do encourage home ownership, they do not condone or force the relaxation of lending standards. Nor does Canada have a Fannie Mae / Freddie Mac that will purchase substandard mortgages, then misstate the quality of loans packaged into securities (technically they misstated / overrated the risk classes [”tranches”]) and sold to wary investors. Finally, Canadian banks, other financial institutions, and investors did not purchase much in the way of US mortgage securities CDOs (collateralized debt obligations) due to a mixture of domestic restrictions and concerns about the value of the financial instruments.

Posted by: SCMike1 | March 9, 2011 12:24 AM | Report abuse

"Gee ... isn't it a surprise that Canada doesn't have a big debt problem and they didn't endure a financial crisis as others did. Things must be well managed north of our boarder."

It also doesn't hurt that Canada keeps to itself and doesn't have these horrible neocons in power forcing us to bounce around the globe wearing a Superman outfit knocking a few trillion off our wealth.

Posted by: mfray | March 9, 2011 8:37 AM | Report abuse

SCMike1, you're blowing my image of you. Having opposing views is one thing, believing in canards is quite another.

Canadian banks didn't do the things that blew up American banks because they're tightly regulated. Banking is a boring business there, as it should be.

The CRA had zero to do with US banks problem. It's a zombie lie. No US bank ever lent one penny to anyone that they didn't want to lend.

Posted by: member8 | March 9, 2011 9:02 AM | Report abuse

PORTLAND, Maine - The federal government Tuesday granted Maine a waiver of a key provision in President Barack Obama's health care overhaul, citing the likelihood that enforcement could destabilize the state's market for individual health insurance.

The U.S. Health and Human Services department said in a letter it would waive the requirement that insurers spend 80 cents to 85 cents of every premium dollar on medical care and quality improvement. Instead, the letter said, the state could maintain its 65 percent standard for three years, with the caveat that HHS intends to review the figures after two years.

The decision makes Maine the first state to receive a waiver of the requirement. Similar requests are pending from Kentucky, Nevada and New Hampshire.


LOLOLOL

Posted by: gopthestupidparty | March 9, 2011 12:40 PM | Report abuse

Socialized medicine in theory and in practice


LOLOLOL

Via instapundit - interesting blog post.

Posted by: gopthestupidparty | March 9, 2011 12:41 PM | Report abuse

Post a Comment

We encourage users to analyze, comment on and even challenge washingtonpost.com's articles, blogs, reviews and multimedia features.

User reviews and comments that include profanity or personal attacks or other inappropriate comments or material will be removed from the site. Additionally, entries that are unsigned or contain "signatures" by someone other than the actual author will be removed. Finally, we will take steps to block users who violate any of our posting standards, terms of use or privacy policies or any other policies governing this site. Please review the full rules governing commentaries and discussions.




characters remaining

 
 
RSS Feed
Subscribe to The Post

© 2011 The Washington Post Company