Why the GOP Will Never Replace Obamacare

Ezra Klein makes the case that Republicans really don't care about health care reform on vox.com.

Republicans are never going to unite around a serious replacement for Obamacare and endure the political pain necessary to get it passed. How do I know? Well, I read Overcoming Obamacare, Klein's excellent book on Republicans and health-care reform. And as Klein writes there, Republicans don't care that much about health reform. "Health-care policy has traditionally only been a motivating issue for conservative activists when it comes to opposing liberal attempts to expand the role of government."

This is the key difference between Democrats and Republicans on health reform. For Democrats, universal health care is a great moral crusade. It's one of the core purposes of the Democratic Party. Democrats wanted to pass health reform more than they wanted to win the 2010 election. They were willing to have the internal party fight over what kind of plan to support, and then to go through the brutal legislative process required to make that plan into a bill, and then go through the political hell of canceling people's plans and implementing their replacement.

Republicans hate Obamacare. But every time they actually try to come up with a plan to replace it, they run into the same damn problem — and it reminds them why they never prioritized health reform in the first place.

The basic project of health reform, at least as it's been understood in American politics in recent decades, involves the government giving money to poor people so they can buy health-care insurance. That money needs to come from somewhere. The government usually gets it from politically unsympathetic constituencies like the rich and corporations, both of which lean Republican. In the case of Obamacare, Medicare cuts were added to the package, meaning another Republican-tilting constituency — the elderly — absorbed the pain.

The problem for conservatives is that making sure poor people have health insurance is politically popular, at least in the abstract. But the plans that achieve it tend to be in tension with both broad tenets of conservatism — they raise taxes, it redistribute wealth, regulate insurers, and grow the government — and with key factions of the conservative coalition.

Health reform turns out to have a liberal bias.

The need to develop and support an alternative to whatever Democrats were proposing has led Republicans, including many conservatives, to back plans they later regret. In the 1990s, for instance, the main Republican alternative to President Bill Clinton's reforms paired regulations on insurers with subsidies for the poor and an individual mandate to force participation by the healthy. Sound familiar?

The bill ultimately failed, but it inspired the Massachusetts health reforms passed by then-Governor Mitt Romney, which in turn inspired Obamacare.