Opinion | Why Is The Republican Party So Confused About Health Care?
That sort of thinking — about both general principles and the specific policy components necessary to make them a reality — is exactly what the Republican Party lacks, and what it desperately needs.
It’s true that some Republican lawmakers have cobbled together proposals of varying degrees of specificity over the year: During his 2016 campaign for the Republican presidential nomination, Senator Marco Rubio of Florida sketched out a mostly forgotten health care plan that would have set up a broad-based system of refundable tax credits intended to subsidize the purchase of insurance in hopes of helping people buy coverage. And during the 2017 Obamacare repeal effort, Senators Lindsey Graham and Bill Cassidy offered a plan to give states far more flexibility, eliminating many of Obamacare's provisions at the national level while essentially turning the program into a block grant to the states.
But these efforts have tended to be cursory and short-lived, with tiny or nonexistent constituencies. Few conservative lawmakers talk about them today, and it’s unclear whether many Republicans in Congress today even grasp the basics.
Which is why, for all these ideas, if you ask Republican politicians what they stand for when it comes to health policy, you are likely to hear slogans like “patient centered” and “preserving the doctor-patient relationship” and possibly something about how Democrats want to “socialize Medicare” — as if the nation’s largest government health program is not already an essentially socialist enterprise.
So it’s possible to imagine that at least some in the party will try to resolve, or at least start acknowledging, some of these questions.
More likely, given the state of the G.O.P. under Trump, who is no one’s idea of a wonk, is that Republicans will simply decline to pursue the issue with any force, and the shabbiness of the party’s current non-position will become even more glaring. Indeed, just this month, Mr. Trump continued to predict Obamacare’s demise, saying he believed that “it’s going to be terminated,” possibly as a result of the Texas case, and that in the aftermath, “a deal will be made for good health care in this country.” What sort of deal? I suspect that even (perhaps especially) the president doesn’t know.
That sort of glibness, in turn, is likely to give already-ascendant Democratic ideas a boost. The party’s enthusiasm for Medicare for All has flourished recently in part because it exists in a vacuum, with little if any substantive competition from the right. There are serious practical and political impediments to making a transition to single payer, from the enormous increase in federal spending and the tax increases it would almost certainly entail to the disruption that would be caused by the elimination of current private health insurance coverage for millions of Americans.