How best to describe the Republican Party's current dilemma? Allow Pascal-Emmanuel Gobry to have a go at it:
The GOP today is like a man standing on the edge of a burning oil platform. Jumping into the sea will almost certainly kill him. But not jumping will definitely kill him. As daunting as the jump is, he has to jump.
By "jump," M. Gobry means "repeal and replace Obamacare," a daunting task indeed--but not if the GOP heeds M. Gobry's advice:
An option that has been endorsed by luminaries such as The New York Times' Ross Douthat and (ahem) myself...would accomplish enough of everyone's goals to have a glimmer of hope of passage, and be good policy. It would involve auto-enrolling everyone in catastrophic health-care plans, a sure political winner ("From now on, no one in America will have to lose their house because they have cancer !" Trump can repeat over and over on the stump), radically decentralizing Medicaid (a necessity), directly funding health savings accounts for the poor, generally increasing the use of health savings accounts and nudging people away from employer-funded health insurance towards portable solutions, and many market-based regulatory reforms. Such a package would accomplish progressive goals of universal coverage and conservative goals of decentralizing health care.
It would be good policy and good politics. And it's actually doable! But not if Republicans have already given up.
Why M. Gobry believes that conservatives in Congress will accept a new entitlement ("catastrophic health-care plans for all!") or increased subsidies to the poor is beyond me; as I've noted before, American politics must look very different when viewed from the other side of the Atlantic. Nevertheless, kudos to PEG for (ahem) solving this heretofore intractable problem.
Speaking of France, Paul Waldman also favors putting a French twist on our health care system:
If I were making the policy, we'd move toward something like the hybrid system they use in France, in which there's a basic public plan that covers everyone, then most people buy supplemental private insurance on top of that. It means virtually no one is uninsured (which would make liberals happy), and you're free to buy the fanciest insurance you want or can afford (which would make conservatives happy).
Since Waldman's proposal would make everyone happy, it's a sure-fire winner, right?
Democrats will benefit from the fact that public sentiment has moved decidedly in their direction. It isn't just that approval ratings of the ACA improved as the Republican effort to dismantle it made people realize what it had accomplished. It's also that the presumptions underlying our health-care debate have changed. As Jonathan Cohn notes, the ACA "has shifted the expectations of what government should do ― and of what a decent society looks like." Republicans found, to their evident surprise, that the idea that everyone in America has the right to health care has now been accepted by the public, and no "reform" that treats health care like a privilege will succeed.
Mr. Waldman is more optimistic than I am, at least so far as the short-term fate of healthcare reform is concerned. But then, his entire scenario is predicated on the assumption that Democrats will return to power in Washington some time soon (or at least in our lifetime); to which assumption I can only say, echoing M. Gobry, bon chance...
Meanwhile, Robert Verbruggen weighs in on a Republican proposal to promote better health in the workplace:
The GOP bill, called the Preserving Employee Wellness Programs Act, resolves these tensions in an employer-friendly way, declaring, contrary to the EEOC’s interpretation, that some major anti-discrimination laws don’t apply to wellness programs. It would also remove wellness programs from the EEOC’s jurisdiction and place them under the authority of several other executive agencies.
Under the bill, wellness programs could require employees to provide information about family members’ medical histories, and could require employees and their families to undergo genetic testing. Protections against sensitive information being shared directly with an employer would be weakened, though it would still be illegal to discriminate on the basis of that information. The bill would also allow higher incentives for participation, up to 30 percent of the cost of family coverage, not just individual coverage.
What's more American, and more empowering, than mandatory genetic testing and disclosure of your uncle's medical history? As Verbruggen explains, conservatives believe that employers, unlike the federal government, only have workers' best interests at heart and would never abuse their power:
Supporters...downplay concerns that employers might acquire and misuse medical information. More broadly, supporters see wellness programs as a free-market-friendly way to bring down health costs and would like to make sure the programs are not overregulated.
Despite clear misgivings, Verbruggen can't quite bring himself to oppose this legislative measure; instead, he points out that it's all the government's fault in the first place:
For decades government policy has given employers a financial stake in their workers’ health--and thus a strong incentive toward paternalism...The question is the role that employers should play in all this, and the steps we should take to ensure they don’t misuse the information they are privy to. 1
Not to worry; I'm sure that if your employer discriminates against you based on the genetic information he forced you to provide, the Supreme Court, led by principled conservatives like Neil Gorsuch, will come to your defense. Or you could always ask your union for assistance--if only you had one.
1 It's revealing that Robert Verbruggen thinks that, absent government pressures, employers would not have "a financial stake in their workers' health": presumably because sick, disabled, or dead workers are easily replaced?