The Conservative case for the ACA

is the title of an op-ed in the New York Times by J.D. Kleinke of the American Enterprise Institute. If you have read my blogging or my book, you will know that I basically agree with him–the political rhetoric around Obamacare never matched the policy reality.

Some predictable push back from Capretta, and Cannon. I like both of these guys personally, and think they have some good thoughts and ideas. However, the opposition to Obamacare, driven in part by them, has always been oversold on policy terms and has been mostly about politics. What would be useful would be for them to be clearer about what they would do instead. In fairness, Jim Capretta has written a fairly complete vision of what a replace of Obamacare would look like, and Michael and colleagues at Cato have an ebook on reform options.

The biggest problem with their replace plans is the lack of 218 members of the House and 60 in the Senate that will vote for their ideas after voting to repeal Obamacare, presumably after a Republican clean sweep this fall. If the President wins re-election and the hope of repeal becomes a fantasy, I think there will be a deal to move ahead on health reform, wrapped up in an overall deal on the tax code, etc. in the next Congress. My book gives my version of such a deal. Here is the big idea of my proposed deal.

update: fixed a link.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

3 Responses to The Conservative case for the ACA

  1. Minivet says:

    I find it instructive to compare Kleinke’s op-ed with this one in the WSJ from this past February, whose last paragraph all but says the most effective way to make insurance affordable is to allow health insurance to be sold across state lines. I wonder what happened between February and now.

    • Don Taylor says:

      Not sure what changed. Selling insurance across state lines is either a bad idea (if you don’t define insurance so people buy ‘cheaper policies’ but don’t really understand what they bought until they need it, or it is non consequential, because insurance companies are not likely to be interested in writing you a policy in a state in which they haven’t negotiated payment rates. For my money, it looks like he stepped away from political rhetoric and focused a bit more on policy….also, ACA allows states to enter compacts to sell across lines in geographies that make sense, I believe.

      • Minivet says:

        To me it seems the difference is that now it seems very unlikely the ACA will be overturned, so there’s new incentive to rationalize it as not so bad from the conservative perspective.

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