Ross Douthat thinks I'm too pessimistic when I say Republicans will never support constructive proposals on health policy.
Given plenty of time and patience, he says they might enact a positive health care agenda.
Of course, that's also what they say about monkeys and typewriters and Shakespeare.
The first moment when a Republican Congress might actually be able to pass a health care overhaul won’t arrive until February of 2017, at which point Obamacare will have been the baseline for two years — the new taxes, the subsidies, the mandates, the higher premiums, the Medicare cuts, the Medicaid expansion, all of it. And at that point, the plausible right-of-center alternatives to Obamacare will no longer look risky and disruptive relative to the status quo, because that status quo will no longer be one that Republican interests and voters are deeply invested in defending. Instead, those interests and voters will be looking for ways to limit the health care law’s impact, and the conservative alternatives will look more like what they actually are — proposals that spend less, regulate less, and reflect a greater confidence in markets than the president’s new law, and that would change the underlying health care system in ways that a sensible G.O.P. should support.
Republicans have been able to see their way clear to defend the pre-Obamacare status quo, in which 50% of health spending in the U.S. comes from the government, and in which we spend about twice as much as peer countries on health care with similar outcomes. And they have often launched their attacks on Obamacare from the left—based on the campaign theme choices Republicans have made in the last two cycles, the sort of "disruption" Republican voters are most afraid of is that Medicare might be cut.
It's hard to see why a system where the government incurs 60% of health spending instead of 50% of it is likely to shock them into sincere interest in policy. Besides which, given the slowing trend in medical inflation, we're probably not even going to see the higher premiums that Ross thinks will motivate Republicans toward reform.
But beyond that, here's my problem with Ross' take: How long are we supposed to wait while Republicans jerk us around on health policy in the vain hope that, some day, they'll stop being full of crap? How many decades do you have to spend being completely insincere on a policy issue before people stop taking you seriously when you talk about it?
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