From a Republican congressional health aide who was "granted anonymity to speak candidly," on the difficulties of creating a Republican plan to replace Obamacare:
The problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act. ... To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.
That's a problem, all right. If you actually want to cover people, you have to pay for it. End of story. Republicans are steadfastly not willing to pay for it, so they aren't going to cover anyone with whatever plan they dream up. No matter what kind of smoke and mirrors they throw up to disguise this, that's the bottom line. No money, no coverage.
Really, though, all this GOP aide is saying is that Obamacare is fundamentally a pretty conservative plan. Liberals nearly all prefer a simpler, cheaper, more comprehensive riff on single-payer of some kind. But that couldn't pass in 2009—even moderate Democrats wouldn't have supported it—so instead we had to cobble together a bunch of conservative ideas into a kind of Rube Goldberg edifice that was at least better than nothing. It only works moderately well, but that's because the conservative take on healthcare is fundamentally incoherent. The more conservative your health care plan, the worse it works.
So Republicans have a choice. They can:
- Introduce a more liberal plan that's cheaper and works better.
- Introduce an even more conservative plan that's more expensive and works even worse than Obamacare
- Toss out a few of the usual pet rocks and just pretend it's a plan.
My money is on Option 3.