Will There Ever Be a Consensus Republican Health Care Proposal?

Republican Members of Congress are like everyone else having to get ready to deal with the possibility of a disruptive Supreme Court decision on Obamacare, as early as the day after tomorrow. It’s easy for them to get ready to for some dishonest spin blaming the chaos on the law’s authors, ignoring the fact that the final draft’s sloppiness was the direct result of a Republican filibuster. And it’s not too hard to prepare to support whatever stopgap “fix” proposal the GOP leadership decides to roll out; the details aren’t important since everyone knows it will contain enough poison pills to ensure a presidential veto.

But eventually Republicans will have to come to grips with what they want the health care system to look like, if not now then in the scenario where their party controls the White House and Congress after a successful 2016 election. And the most scathing indictment I’ve read of their lack of preparation for this responsibility is not from some liberal defender of Obamacare; it’s from Peter Suderman, senior editor at the libertarian periodical Reason, writing at Politico Magazine. He has an apt analogy for GOP health care plans:

Republican health plans are the policy equivalent of what the tech industry calls vaporware—products that are perpetually in development, and are sometimes even previewed or demonstrated, but never quite make it to market. This is the way it always is for Republicans and health policy: a handful of options but no consensus—and the real plan, whatever it turns out to be, is coming soon, but not yet.

Suderman basically argues that Republicans never quite transcended their decision in battling the Clinton Health Plan to abandon any effort to develop a constructive alternative, while Democrats viewed the failure of ClintonCare as a learning opportunity.

Obamacare, in other words, was ClintonCare’s second act—the culmination of more than 15 years of work and consensus building. To put it another way: Republicans never started working on health policy; Democrats never stopped.

To be sure, there’s been a flowering of conservative health plans in recent years, and a debate on the sidelines; journalist Philip Klein’s excellent e-book Overcoming Obamacare summarizes the three major right-of-center schools of thought on how to reform or replace the president’s health law: the “reformers” who want to use Obamacare to remake the rest of the entitlement system, the “replacers” who want to scrap Obamacare’s coverage expansion in favor of somewhat more market-friendly, GOP-devised alternatives and the “restarters” who argue that expanding coverage should take a backseat to making health care and insurance more flexible and affordable.

But with a few exceptions—legislators like Paul Ryan and Tom Price—interest in most of these ideas is limited to a handful of dedicated conservative and libertarian health wonks. How many GOP legislators on Capitol Hill could summarize the basic tenets’ three major camps, and the debate between the three?

More typical are remarks like those from Rep. Pete Sessions (R-Texas), who in a 2013 floor speech made the strange and incoherent argument that Medicare (an entirely federal program) and Medicaid (which is partially funded by states) were too expensive because the federal government wasn’t paying enough, and also that Obamacare couldn’t work because it interfered with America’s vibrant free-enterprise health care system.

So there really does need to be some rather serious catching-up and decisionmaking by Republicans on health care reform even if (as most analysts still expect) SCOTUS upholds Obamacare subsidies this week or next.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.