My debate with Jim Capretta

On Wednesday night, I debated Jim Capretta of the Ethics and Public Policy Center on the question “What is the best way to provide high quality, affordable health care to all Americans?”

Here is a link to the video of the debate (about 90 minutes long). I am not so experienced in this format, but had fun doing it, and enjoyed meeting Jim, who is a nice guy. My main goal was to give my version of how we got to where we are, 10 days from the Supreme Court oral arguments on the constitutionality of the individual mandate and the Medicaid expansions as part of the ACA, to point out that Conservatives and the Republican party do not have a coherent vision and certainly not a practical replace plan, and to then to paint a vision of where we next need to go as a country on health policy.

• For progressives, achieving universal health insurance coverage of some sort is the holy grail of public policy. The degree to which it is a priority was demonstrated by the use of “the other sides” individual mandate along with a Medicaid expansion to expand coverage. Plenty of progressives held their nose, because they knew this pushed the ball down the field toward their broader goals. The ACA is simply what could get 218 votes in the House, 60 in the Senate and 1 in the White House. Any replace bill or modification will have to do the same.
• The ACA is a good step, in large part because it was a step toward universal coverage and it has some aspects that could allow us to address costs and quality. We need more steps, but repeal without having a clearly defined modification or replacement strategy is a move backwards, in large part because there is no reason to believe that conservatives would be able to marshall 218 votes in the House, 60 in the Senate and 1 in the White House on any reasonably comprehensive health bill.
• We need a political deal, with the ACA as the basis, because that is what we now have.
• I laid out my suggestions for what this deal should like in terms of the next steps after ACA. These ideas are a central part of my book, Balancing the Budget is a Progressive Priority (coming out in April 2012).
• What was most striking to me in listening to Jim talk about his ideas for reform was how similar many of them are to what is contained in the ACA; not the same, but the ideas are cousins. The reality is that if you are against government insurance expansion and an employer mandate, then some form of an individual mandate is the only option if you are going to claim to have a goal of addressing cost and quality while moving towards covering everyone. You have to pool risk somehow. The rhetoric that has been used against the ACA has never made sense in light of its policy realities, or the reality of what is possible if it goes away.  As I said in the debate, I would to see CBO score the Patients’ Choice Act, after it were marked up by one of the House committees. Then the Republican Party would have some credibility on replace. Now they have none. It is much easier to say what you are against than it is to do better.