Ross Douthat is on a roll lately. He points out that the recent Oregon study indicates that expanding health care coverage isn’t the most cost effective way to improve the well being of the poor and lower middle-class. I would agree, but I would put the emphasis in different places, not because Douthat is wrong, but because Republican politicians might hear him wrongly.
The Oregon study’s finding that expanding Medicaid had a statistically insignificant impact on the health of beneficiaries could be used by many Republican politicians as an excuse to ignore health care policy beyond making some gestures in the direction of repealing Obamacare. That would be a mistake because the Oregon study indicates that policies developed by conservative wonks might be the way to go, and that adopting those policies could expand the appeal of the Republicans.
The Oregon study found that expanded health insurance coverage was good for several things. It protected beneficiaries from financial shocks from catastrophic health costs and it increased their peace of mind. All of this is to say that health insurance is more valuable as insurance than as health. It is nice to see that the political culture is catching up with David Goldhill. That doesn’t mean that health insurance is not important to families and that it is not an important political issue. If you were to somehow abolish the health insurance of most middle-class American families, the response of those families would probably be a slow and quiet panic even if the health of the families stayed the same month in and month out. Republicans are only injuring themselves if they seem indifferent to public’s desire to have coverage or to people’s frustration with premium increases that eat into their disposable income.
What Republicans can do is use the findings of the Oregon study and the work of conservative wonks to address people’s health care and earnings concerns. Republicans could take on the Obamacare model of comprehensive health care prepayment as eating into people’s wages and imposing unnecessary burdens on taxpayers. Republicans could argue for moving health care financing to a model of catastrophic health insurance coverage, plus coverage for routine preventive care, plus health savings accounts to pay for non-catastrophic health care costs. James Capretta has been working on this. Republicans would be able to plausibly argue that their plans would maintain the health care security of middle-class families while reducing health care premiums and expand health insurance coverage for low-earners at lower cost to taxpayers than Obamacare. Republicans can be the party of health care security and more take home pay and lower spending. C’mon people. You can do this.
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