The New York Times' Ross Douthat has responded to my post on Republicans and health care. He agrees that many Republican elected officials have little interest in implementing an alternative health care reform -- that they are far more likely to repeal Obamacare than to replace it.
But he notes that many conservative policy thinkers are serious about alternative reforms, and asks what option they have but to advocate their plans to a reluctant Republican Party, in hopes that eventually, they will listen:
There’s no guarantee that this attempt will succeed (I’m certainly not wildly optimistic), but such attempts are part of the legitimate work of punditry — the point of which isn’t just to describe the world, after all, but to try to change it as well. … Given that [Paul] Ryan, Tom Coburn and others are currently at least somewhat more serious about Obamacare alternatives than the party as a whole, I don’t see any reason why conservative commentators can’t hope that the same process will play itself out if and when the G.O.P. is actually confronted with a repeal-and-replace scenario.
I have two responses. One, this hope is very slim. The Republican Party is united in its desire to repeal Obamacare. It is not united on a replacement: Some Republicans want to go back to the pre-2009 status quo, some are pretending to be interested in a replacement reform, some are sincere in their desire for alternative reforms but do not necessarily agree with each other on how that should work.
The overwhelming likelihood is that, given power, Republicans will be able to reach agreement on repeal but not on replace -- and everyone who wants to give the impression that they really tried to "replace" will be able to do so.
That said-- and here is my second response -- Ross is right that pundits and scholars who favor a more conservative health reform should advocate their preferred plans to Republican lawmakers. But these thinkers should also grapple with the likelihood that no replacement plan will get enacted, and answer the question that logically follows: Is Obamacare really so bad that we're better off with no reform at all?
That's a tough case to make -- much tougher than the case that some theoretical reform is superior to Obamacare. It involves contending that the health-care law is so unacceptably damaging that it's worth leaving 30 million Americans without insurance to get rid of it.
And if conservative health wonks can't make that case, they should go on to say that repealing the health care law should be contingent on passing a suitable alternative plan to replace it. That would put more pressure on Republican lawmakers to be serious about replacement, and make a conservative health reform more likely.
(Josh Barro is lead writer for the Ticker. Follow him on Twitter.)
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