This editorial will appear in tomorrow’s print edition.
OK, Republicans, let’s see your health care bill.
The new GOP majority in the U.S. House of Representatives is poised today to repeal last year’s Affordable Care Act (or “Obamacare” – take your pick). It’s an empty gesture as far as lawmaking goes: The Democratic majority in the Senate won’t second the motion, and President Obama certainly wouldn’t sign a repeal of his signature legislation.
But Republicans hope to follow up with piecemeal attacks on the 2010 package that might eventually gut it. The fattest target is the law’s requirement that most Americans carry health insurance. It’s unpopular; it’s also a way to prevent freeloaders from buying insurance after they get sick, then dropping it as soon as they’ve had their babies or their hip replacements.
The Affordable Care Act promises to do the job of extending medical coverage to most Americans, but it is not a work of art. A repeal would be fantastic – if the law were being replaced with something better. The problem is, congressional Republicans aren’t offering a better bill. In fact, they’re offering no bill at all.
They do have ideas, and some of them could be good if done right. They include more tax credits to help Americans buy medical coverage; tighter limits on lawsuits against doctors and other providers; less expensive policies with stripped-down, basic benefits, and health savings accounts that encourage people to sock away their own money to pay for future care.
Ideas are not bills, though. One virtue of the Affordable Care Act is that it is real. Its price has been vetted by the Congressional Budget Office, and its warts and dimples are out there for the world to see. That beats vague talk about malpractice costs and the free market.
There’s a problem with the “market-based” solutions many Republicans tout: America hasn’t had a genuine free market in health care for more than a half-century, and the damage has long since been done.
Since the 1940s, when the U.S. government offered huge tax incentives for employer-based insurance, most Americans have been insulated from the actual price of their own care. The system has invited overuse.
In the 1960s, Medicare made the insulation thicker for patients and doctors alike. For many years, the program simply wrote checks on demand, which escalated costs and encouraged expensive, procedure-intensive medicine. There’s no getting back to the days of the $5 house call.
Given that reality, it’s hard to see how the working poor can get coverage without subsidies and mandates. Health savings accounts, for example, work only if you’ve got serious money to sock away in them.
If the congressional Republicans have a rabbit hidden in their hat, now’s the time to pull it out. We’d love to get a look at their real-world alternative to the Affordable Care Act.