Fifty Shades of Not-Gonna-Happen


Karl Rove’s op-ed in the Wall Street Journal isn’t exactly a moving target. If “Republicans Do Have Ideas for Health Care” sounds petulant (I know he didn’t write the headline, but it fits), you’re not alone, although the sentence itself is strictly true. The rest, well, not so much. Alternative titles that were rejected may have been along the lines of “We Do Have a Wishlist of Ideas That May Not No Probably Will Not Okay Will Never Happen.” I’m sure you can understand why they went with the version they did.

I’ll just excerpt the beginning:

In remarks at the White House last month, President Obama claimed that if Republicans “had some better ideas” on health care, he was “happy to hear them. But I haven’t heard any so far.”

The Democratic National Committee expanded the president’s charge, claiming in a press release last week that “the GOP is simply out of ideas” on health care. Liberal opinion writers are now echoing Mr. Obama. The Washington Post’s Ezra Klein writes that “Republicans have no idea what is it is they’ll do” to replace the Affordable Care Act. The New York Times’s Paul Krugman chimes in that the GOP goal is to “deny essential health care and financial security to millions of their fellow Americans.”

Mr. Obama and his hallelujah chorus are wrong. Republicans have plenty of sensible ideas to make health coverage more accessible and more affordable.

Rove is half-right here; they do have ideas. They’re just not particular good (or new). Some of them are even already addressed by the Affordable Care Act. He goes on to list the usual suspects — decoupling ESI (which isn’t even a conservative idea, nor lacking near unanimous support), small business risk pooling, selling policies across state lines, tax-free health savings accounts, tort reform, pricing transparency, privatization of Medicaid. For a line-item response to all these go read Aaron Carroll, but the “hallelujah chorus” isnt totally off-base here. Republicans have spent a lot of time repealing health care reform and approximately zero seconds replacing it. It’s the latter that gives heft to the idea that the GOP has no idea what to put in place of the ACA.

There’s a good reason for that. Voting on a replacement reform plan means putting forth a bill in committee, having it marked up it, and subsequently analyzed by the Congressional Budget Office. The resulting scorecard from the CBO would probably show fewer people being insured, much higher expenses for the sick, and be particularly detrimental to the poor. To achieve something other than that outcome they’d have to produce a comprehensive conservative alternative that doesn’t come close to resembling the Affordable Care Act. Good luck.

Yet there is a broader roadblock to all this, covered by Kevin Drum here (my emphasis in bold):

Actually, liberals have a fundamental, philosophical objection to the tired repetition of stale ideas that (a) plainly won’t work, (b) have no political support, and (c) contra Rove, inspire no genuine passion among Republicans other than as a way of pretending that they have a health care plan.

The first is subjective, the second can change after any given election, but the third; that’s the Great Wall of Conservative Obstruction to a replacement. All of the passion, all of the power to elicit pandering at town hall meetings, and every bit of the vitriolic activism from the right is squarely directed towards having no health care plan. Spend any amount of time on comment threads to GOP Facebook posts or from the #tcot crowd on Twitter and this is the message; repeal, defund, repeal, rinse, repeat. The August recess for House Republicans has primarily been an exercise in defending themselves from the right on this issue even after having voted — for the 40th time — to prove their anti-ACA purity.

Genuine conservative passion for comprehensive health care reform that doesn’t leave more people under-insured or uninsured would require a seismic shift in anthropological perspective. Conservative passion demands the government do less to ensure affordable access to health care, not more. Conservative passion demands spending less money on low-income Americans — in every program that conceivable attempts to mitigate hardship — not more. This orientation towards public policy is a bedrock principle of movement conservatism at the local, state, and national level.

So allow me to be the Bill towards any notion that this reality is different. Do you find me pessimistic? You know, I’ll bet I could fry an egg from the heat of conservative hatred towards the ACA right now if I wanted to. No, Optimist, I’d like to believe you’re aware enough, even now, to know there’s nothing pessimistic in my opinion. Maybe towards these op-ed’s like Karl Rove’s, but not you. No, Optimist, this moment, this is me at my most … unidealistic.


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