[Leaving aside the obvious things wrong with this plan -- that it leaves $400B *a year* on the table for no good reason; and that this is why it will quickly go bankrupt, like Dukakis-care before it -- I think this is nice concise description of where Obamacare comes from, and how -- how!? -- so many different mainstream pundits end up implacably converging on like magnet filing on absurb Rube Goldbergian scheme that even they can't understand clearly. If you won't give up the premise that we have to keep private insurers, this is the only thing you can end up with to produce universal care.]
[And though he might not inflect it with quite the vehemence I do, Krugman's conclusion is perfectly right: Obamacare is literally the most conservative scheme possible.]
http://krugman.blogs.nytimes.com/2011/04/25/the-road-to-romneycare
April 25, 2010
Paul Krugman - New York Times Blog
The Road to Romneycare
Yglesias looks at calls for a return to something like the McCain
health plan -- subsidies for individuals to buy insurance on the open
market -- and gets it exactly right: once you think seriously about how
this would work, you end up with something that looks very much like
the health reform we have.
Suppose we give people help buying insurance. This doesn't help people
with pre-existing conditions, who won't be able to get insurance
anyway. So we add community rating: insurers can't discriminate based
on medical history.
But this leads to a problem with adverse selection: healthy young
people will drop coverage, leaving behind a bad risk pool and high
costs. So we add a mandate, requiring that everyone get coverage.
But some people can't afford to do this. So we add means-tested
subsidies to help lower-income citizens.
And you've just described the Massachusetts health reform, aka
Romneycare, which in turn is basically the same as Obamacare.
There are no more conservative alternatives -- not unless you give up
on the whole idea that everyone should have coverage. There are
alternatives to the left -- single-payer, VA-style government provision
-- but Obamacare is already as conservative as a plan to make health
insurance more or less universal can be.