By Ramesh Ponnuru
Monday, October 24, 2016
One of President Obama’s cherished conceits is that
disagreement with him can have no rational basis, and it was the theme of his
most recent speech in defense of his health-care law.
Only “ideology” and “politics” are keeping Republicans
from working with him to expand Obamacare’s reach. He himself is, as always in
his self-portraits, the picture of reasonableness, willing to accept
Republicans’ ideas if only they would operate in good faith instead of holding
“60-something repeal votes.”
Obamacare has substantially increased the number of
Americans who have health insurance, as the president boasted. Some of his
other claims -- notably, “This law has actually slowed down the pace of health
care inflation” -- are more dubious.
But the core problem with his speech was not that he
overestimated the merits of Obamacare (as much as I believe that he did). Nor
was it the partisan silliness in which the president sometimes indulged. It’s
that he refused to acknowledge that conservatives have reasonable disagreements
with him about the direction of health-care policy.
Obama believes that only comprehensive insurance policies
are real insurance. Conservatives generally believe, by contrast, that people
should be free to buy cheaper policies that protect them only from financial
catastrophes arising from their health needs.
It’s a difference that leads to others. Obama says that
people who are having trouble buying insurance on Obamacare’s exchanges should
receive more generous subsidies. The conservative alternative -- relax the
regulations that make the insurance unaffordable for them -- is unacceptable to
him because it would be a retreat from comprehensiveness.
All of the president’s shows of open-mindedness include
similar caveats. He noted that Obamacare allowed state experimentation. But
that experimentation is allowed to proceed only if the experiments promise to
end with at least as many people having coverage that is at least as
comprehensive as what Obamacare delivers. A policy that resulted in more people
having catastrophic coverage wouldn’t qualify.
Obama claims that Republicans have offered no
alternatives to the health-care law. They have in fact outlined their own
far-ranging plans for health policy. But it’s true that they have not offered
alternative ways to get just as many people covered as comprehensively as
Obamacare does.
If you start with Obama’s assumptions about what the
goals of health policy should be, then it is true that there is no reasonable
basis for rejecting his policies. But those assumptions are not self-evidently
correct.
A lot of conservatives want a less regulation-heavy
system, where everyone has access to relatively cheap catastrophic policies.
Obama’s speech offered no reasons for them to stop wanting that or trying to do
what they can to move health policy in that direction.
This doesn’t mean that Republicans should insist on
making no changes to health policy that fall short of replacing Obamacare. And,
in fact, they have not insisted on that.
They have advanced legislation to fix what they see as
specific problems with the law, such as its medical-device tax and its
prohibition on some people’s existing health policies. But of course
conservatives are not going to agree to changes to the law that move the
health-care system further away from what we want.
Obama resorted to a number of ill-considered analogies in
making his pitch. One likened Obamacare to a “starter home”: “It’s a lot better
than not having a home, but you hope that over time you make some
improvements.”
Sometimes, though, you decide that you want a different
kind of home altogether, and work until you can move there.
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