Republicans’ Phony Obamacare Replacement
A mere 48 months after the law was introduced, only 42 months after it was signed, with just two weeks until one of its main provisions takes effect, Republicans today finally offered their alternative to the Affordable Care Act.
Which would be cause for genuine (if belated) congratulations, except for one thing: It’s not really an alternative. Understanding why can help clarify the U.S.’s seemingly endless debate about health care.
The Republican bill would give individuals tax deductions to buy health insurance, expand tax-free health savings accounts and limit insurance premiums for people with pre-existing conditions. What it wouldn’t do is expand coverage to the same number of uninsured Americans -- about 25 million, according to the latest estimates -- as Obamacare.
That last point may seem like one among many, but it’s not. The most important achievement of the Affordable Care Act is that the law attains something like universal health care in the U.S., closing an embarrassing and indefensible gap between it and every other developed country.
That means any plan billed as an alternative has to meet one definitional threshold, and only one: covering a similar number of Americans as Obamacare. To go a step further and be a better alternative, a proposal should cover a similar number of Americans at a lower cost or with fewer unwanted consequences. The documents Republicans released today are conspicuously silent on how many additional Americans would be covered.
Until now, the Republican “repeal and replace” strategy on Obamacare has been to pretend that an alternative to Obamacare exists without saying what it is. Today’s proposal is the logical culmination of that cynical strategy: calling something an alternative, and hoping nobody notices that it’s not.
Republicans are within their rights, of course, to oppose the goal of publicly funded universal health care. They are also free to ask how much money the U.S. should spend to reach that goal and whether the country can afford it. But these are essentially political questions.
Republicans now face at least three choices. They can continue to argue that ensuring universal health care is not a proper role for government, and try to persuade voters to agree with them. Their obstacle here is that the Affordable Care Act is already the law of the land and has been validated not only by the U.S. Supreme Court but also by the re-election of the president who signed it.
Alternatively, Republicans can come up with another way for the government to provide universal health care. Or they can concede that Obamacare is the best way to do so, and move on to other debates.
What’s not helpful is to try to fool Americans with semantic games. Republicans like to talk about the importance of making hard choices. The hardest choice of all may be making their position more explicit: that universal health care is not a worthy goal for government. Today’s proposal shows they have yet to find the courage of their convictions.
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