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The Health Care Debate Underscore the Fundamental Problem with the GOP

Via WaPoGOP lacks clear health-care plan

House Republicans have termed their strategy “repeal and replace.” But according to GOP House leaders, senior aides and conservative health policy specialists, Republicans have not distilled their ideas into a coherent plan.

[...]

In the absence of a plan, Republican leaders nevertheless are eager to convey that they have ideas about health care – and are not merely trying to knock down those of the Democrats. As a result, they have drafted a resolution to accompany the repeal legislation. It lays out broad, long-held GOP health-care goals, but no specifics, and directs four House committees to develop proposals.

Now, I recognize that any repeal in the House will almost certainly fail ever to be taken up in the Senate, let alone voted out of that chamber (not to mention the President’s veto pen), so one could make the argument that this is all symbolism anyway, so why bother countering with an actual proposal?   However, if the argument is that the Republicans actually have a viable alternative to the PPACA, then this is an excellent time to unveil it.  Use the power of the House to go beyond basic symbolism to actual action, even if it is action that will die once it leaves the chamber.   If governing is the actual goal here, rather than winning elections, then the Republican Party desperately needs to get away from “broad..goals, but no specifics” to making real presentations.  This approach is identical that which the party is taking on fiscal policy, i.e., they are committed to “fiscal responsibility” and “cutting spending” but can’t muster an actual plan.

And, by “plan” I mean actual proposed legislation, not pontification by a given member of Congress or pundit or even a white paper issued by a think tank.

And, I would note, that I say all of this as someone who for most of his voting life considered himself a Republican, but currently am a Man Without a Party, because I cannot stomach directly affiliating myself with the above approach. I keep thinking about, of all people, Rush Limbaugh, who for years used to rail (and I assume still does) against “symbolism without substance”—a charge he constantly leveled at liberals.  However, I can think of no better slogan for the GOP at the moment.

At the moment it appears to me that the Republicans are subsisting on vague fantasies rather than actually taking up the hard work of governing, which requires concrete proposals and a long-term strategy to attempt to implement them.

Two other health care related notes:

1)  While I understand the logic of the following, it is actually a fairy radical approach (and not a conservative one in the true sense of the word) as it would substantially restructure how health care is provided to both the elderly and the poor:

Part of a broader plan to reduce the deficit, Ryan’s approach would diminish the nation’s reliance on employers to provide health coverage by removing the tax preferences companies receive for insuring their workers. Instead, the government would give Americans tax credits to shop for insurance on their own. Ryan’s plan also would redefine the nation’s large public entitlement programs: Medicaid for the poor and Medicare for older Americans. Except for those now on Medicare or close to being eligible, the program would switch to giving people a “defined contribution” – that is, a federal payment toward their coverage – rather than the traditional “defined benefit,” guaranteeing specific coverage no matter how much it costs.

That’s hardly incremental change in the constant of not trusting government to make radical policy changes.  If one of the argument against the PPACA is that it will lead to a host of unintended consequences, such a criticism has to be leveled at Ryan’s plan above.  Indeed, it would represent a fair larger alteration to the structure of health care in the US than does the PPACA (which does, like or it not, simply further institutionalize the current system).

2)  The following note underscores the fact that claims that the PPACA is unpopular are undercut by the following:

A few parts of the GOP proposal overlap with provisions of the new law. Among them are high-risk pools – special coverage for Americans who are rejected by insurance companies because they already are sick.

Like the new law, the GOP version also would have allowed young adults to remain on their parents’ insurance policies longer and would have tried to give consumers more information in choosing insurance.

None of the above is shocking, but it underscores that while “Obamacare” may not poll well, a lot of its individual pieces do.

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About Steven L. Taylor
Steven L. Taylor is Professor and Chair of Political Science at Troy University. His main areas of expertise include parties, elections, and the institutional design of democracies. He is the author of Voting Amid Violence: Electoral Democracy in Colombia and is currently working on a comparative study of the US to 29 other democracies. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging at PoliBlog since 2003. Follow Steven on Twitter

Comments

  1. john personna says:

    Who knew that the Republicans, of all parties, would become post-modernist.

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  2. DMan says:

    “If governing is the actual goal here, rather than winning elections, then the Republican Party desperately needs to get away from “broad..goals, but no specifics” to making real presentations. ”

    But the broad goals, no specifics platform they ran on was “government is bad”. Winning with such a platform makes governing difficult. It inevitably leaves them with repeal only solutions. If their goal is governing, their platform needs to shift. Since they were voted in on their current platform that is unlikely to happen.

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  3. floyd says:

    “Of all parties”

    Yeah just consider the plethora of realistic alternatives we have! (lol)

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  4. anjin-san says:

    And if the GOP has no real interest in governing, why are they there but to collect the spoils of office?

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  5. May I challenge your assumption that it is the government’s responsibility to provide a utopia where all are cared for according to whatever the sentiments of the day may be without regard to cost or efficacy? At what point can we begin to judge programs by their actual results rather than their intentions?

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  6. @Charles:

    Where did I assert anything anywhere even close to that? Seriously: where?

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  7. anjin-san says:

    Charles,

    The other day you ducked out on a number of valid questions about what you would do if your family had health care problems which exceeded your means, and turning to the government for help was your only option. I would be interested to hear an answer. Are half-baked anti government screeds all you have to contribute?

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  8. anjin-san says:

    > Where did I assert anything anywhere even close to that? Seriously: where?

    This is a fascinating phenomena. Is Charles actually hearing what he says he is hearing? Or is this simply a right wing attack dog response to anyone or anything that deviates from the party line? You want to have an actual nuanced discussion of the issue and examine different points of view? Fine. You are a communist.

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  9. mantis says:

    If governing is the actual goal here

    It isn’t. Hasn’t that become painfully clear?

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  10. An Interested Party says:

    It’s a tad difficult for a political party that preaches a rabid message of “government bad!!!” to actually govern effectively once it gains power…

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  11. mantis says:

    Charles, like most wingnuts, does not debate actual people. Just the ones he has created in his head. Any attempt by actual humans to respond will be futile, as he will only hear from a phantom version of you built from Limbaugh and Hannity routines. The actual you doesn’t really exist to him, only the evil liberal bogeyman.

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  12. steve says:

    The Republicans have had years to propose a plan, and little has been forthcoming. I have been thinking about this, and think that there are at least two areas they could approach. One is malpractice reform. Research indicates this will not provide a lot of savings, but should give some. Since states control malpractice issues, the GOP would need to invoke the Commerce clause or use the taxing power to institute this reform.

    Second, they could try to sell insurance across state lines. Actually, they can do that now, so what they really mean is that they want to do away with state mandates. I think that is a clearer case for the Commerce power. This may, paradoxically, lead to docs making more money if not done correctly, so I would prefer a trial in a couple of states.

    Steve

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  13. Ben Wolf says:

    Steve,

    The three most effective things that can be done to control costs (if that is the actual goal) are:

    1) Ban insurance companies from earning profit.

    2) Minimum standards on the percentage of money to be spent by insurance companies on administration and overhead versus actual health care.

    3) Collective bargaining on health care costs.

    Anything else, whether it be malpractice reform or selling insurance across state lines, is just nibbling at the edges. You’ll notice that neither party supports anything I’ve listed.

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  14. Dr. Taylor,

    However, if the argument is that the Republicans actually have a viable alternative to the PPACA, then this is an excellent time to unveil it. Use the power of the House to go beyond basic symbolism to actual action, even if it is action that will die once it leaves the chamber. If governing is the actual goal here, rather than winning elections, then the Republican Party desperately needs to get away from “broad..goals, but no specifics” to making real presentations.

    That reads to me as though you believe the Republicans have to offer some alternative to Obamacare, or accept it. My apologies if I have taken that incorrectly.

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  15. Anjin-san, I’m not wasting time responding to your automatic gainsaying of whatever I say.

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  16. I will note that a recurrent assumption throughout the comment thread is that the provision of healthcare is a government responsibility. Now where would that idea come from?

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  17. george says:

    “I will note that a recurrent assumption throughout the comment thread is that the provision of healthcare is a government responsibility. Now where would that idea come from?”

    The electorate? Even most of the ones against this program seem to like Medicare, which is gov’t healthcare.

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  18. @Charles:

    That reads to me as though you believe the Republicans have to offer some alternative to Obamacare, or accept it. My apologies if I have taken that incorrectly.

    Well, they themselves are calling it “repeal and replace.” As such, it behooves them to say what the replacement would be.

    Further, there is going to be health care policy of some kind one way or another. As such, I found your assertion that I was calling for “the government’s responsibility to provide a utopia where all are cared for” was puzzling (and, honestly, remains such unless your position is that the government should have no involvement whatsoever in this policy area).

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  19. @Charles:

    I will note that a recurrent assumption throughout the comment thread is that the provision of healthcare is a government responsibility

    I suppose it depends on what you mean by “government provision.”

    As it stands, we have Medicare, Medicaid, Tricare and the VA (all of which have been in existence for decades), regardless of the PPACA>

    Also, the fact that most of get our insurance from our employers as part of our compensation package is an artifact of government policy.

    Further, there is going to be some government regulation of health care no matter what (or do you want drugs only regulated by the free market and no regulations for health care providers whatsoever?).

    The bottom line is not whether or not there is going to be a role for government in health care, the question is what is it going to be? It is incumbent upon the GOP to provide some kind of vision, which they are currently not doing.

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  20. anjin-san says:

    > Anjin-san, I’m not wasting time responding to your automatic gainsaying of whatever I say.

    In other words, its a question you can’t answer without revealing the total bankruptcy of your position. Got it.

    I note that you don’t mind wasting Steven’s time with your rather bizarre interpetation of his remarks. I guess only your time has value.

    You, bithead, Jay Tea, Zels, Plunk. All cut from the same cloth. When asked to present some viable alternatives to the government solutions you seem to so despise, you mutter a few platitudes about liberty and the free market, and throw is a little bit of victim pathos for seasoning.

    The one thing that is clear is that you don’t have a fricking clue as to how we might deal with some of our problems and have smaller government at the same time.

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  21. anjin-san says:

    > Well, they themselves are calling it “repeal and replace.” As such, it behooves them to say what the replacement would be.

    No, no, you have it all wrong. We have to wait until the replacement is made before we can find out what the replacement is.

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  22. tom p says:

    Really Charles, I am still waiting…

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  23. An Interested Party says:

    I notice that some conservatives are just so infuriated that the government has its dirty little hands in so many thing, like health care…but do these people really believe there is some way to reverse this? Sorry guys and gals, but that horse has left the barn and there’s no changing that…

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  24. floyd says:

    Aip;
    You are probably “right”… no uh… correct.
    Not much hope of Obama waking up with that horse’s head under his sheets!

    Of course he sees the other end in the mirror every morning! {lol}

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  25. Dr. Taylor, my apologies for putting words in your mouthm that was not my intention.

    Anjin-san, et al, as I said, I’m not wasting time responding to bad faith actors. Have a nice life.

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  26. anjin-san says:

    > Anjin-san, et al, as I said, I’m not wasting time responding to bad faith actors

    I see. My politics differ from yours, so I am a “bad faith actor”. The love of democracy that flows from the right is truly heat warming.

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  27. Steve Plunk says:

    A flat repeal to what we had before is better than Obamacare so why should the Republicans have to formulate anything? Kill it and quickly.

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  28. An Interested Party says:

    “Kill it and quickly.”

    Oh, good luck with that…

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  29. sam says:

    “A flat repeal to what we had before is better than Obamacare so why should the Republicans have to formulate anything?”

    Heh.

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  30. @Steve:

    A flat repeal to what we had before is better than Obamacare so why should the Republicans have to formulate anything?

    Because:

    1. There isn’t going to be a flat repeal.

    2. The only way to create enough political capital to makes repeal happen is to convince people you have a better option.

    3. Hence, a new plan has to be proffered if repeal is to be considered a political possibility.

    To sit around and talk like a straight repeal is a real possibility is to ignore a number of salient facts, not the least of which being Democratic control of the Senate and White House.

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  31. george says:

    Is there any official republican position on why gov’t involvement in healthcare is bad, but Medicare (which is gov’t involvement in healthcare) is good?

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  32. Tlaloc says:

    “I will note that a recurrent assumption throughout the comment thread is that the provision of healthcare is a government responsibility. Now where would that idea come from?”

    *raises hand*

    uh… I think that idea came from the rest of the world which by and large has government provided insurance (at least) and also by and large 9so long as we talk about other first world countries) has better and cheaper health care than we do.

    In other words if we want to learn from success (instead of our own miserable failure) we need to look at moving away from the insane policy of making health care a for profit industry on every level.

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  33. [...] GOP Should Have Its Own Proposal, Outside the Beltway’s Steven L. Taylor [...]

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