The Republican mantra on healthcare reform is "Repeal and Replace." But replace it with what? Ross Douthat has some ideas, one of which is this:
Republicans should work to deregulate the new health care exchanges, so that high-deductible, catastrophic coverage can be purchased as easily as comprehensive plans.
But as Jon Cohn points out, PPACA already supports high-deductible plans:
Look closely at the standards for coverage in the insurance exchanges: The minimal, or bronze, insurance option allows out-of-pocket spending of up to $12,500 for a family of four. The actuarial value is 60 percent, which means, very roughly, that the plan only covers about 60 percent of the average person's medical bills. Those are some pretty high deductibles!
Ross's second idea is to limit subsidies for low-income workers, which, needless to say, guts the entire point of the bill. His third is to tweak the individual mandate in ways that, as Jon Chait says, are probably sensible. Unfortunately:
There's little reason to believe either that these objections represent the right's real problem with the Affordable Care Act or that they're willing to consider any tweak to improve the law.
The conservative base has simply been whipped into such a frenzy on this issue that it's impossible to imagine Republicans making any change that isn't designed to lead to full repeal. There's a reason why conservative magazines and writers keep repeating the slogan "Repeal" endlessly. It's more a point of honor than policy. The Affordable Care Act has become, in the right wing mind, a monstrosity, a completely illegitimate assault on American freedom, and an emotional wound that conservative elites work very hard to ensure never heals.
Of course, it's very helpful for conservative elites like Matthews and Douthat treat the right's objections to the individual mandate (a policy tool Republicans either supported or had little objection to up until 2009) at face value. Eventually conservatives will make their peace with health scare reform, and either put their policy imprint on it or not. But in the meantime the overwhelming conservative impetus is to sabotage the law by any available means. A reform to the law that satisfies objections to the individual mandate, but that does not satisfy the urge to repeal the bill, will be seen by most Republicans as untouchable.
Is there any serious argument that Jon is wrong about this? Republicans have never taken universal healthcare seriously, after all. In fact, as near as I can tell, they're philosophically opposed to the whole idea, regardless of how it's implemented. Wonky healthcare proposals from various corners of conservativedom should mostly be thought of not as serious plans, but as useful window dressing that allows conservatives to claim on Sunday chat shows that they do too have constructive ideas about healthcare. But the plain fact is that none of these comprehensive proposals could get the support of even a quarter of the Republican congressional caucus. Maybe not even that much. Republicans have had plenty of time to think about this, and if they seriously thought that a Douthat-esque plan was a good idea they would have proposed it long ago. They didn't, and they're not going to this time around either.