Health Care Politics in One Sentence

Health Care Politics In One Sentence
by Paul Krugman
The politics of Obamacare are clearly starting to shift. It’s not that the public is coming to love it — not yet, anyway. But it’s less and less of a bogeyman, with polls suggesting a majority of the public against flat-out repeal. So there’s increasing pressure on Republicans to lay out an alternative — and continuing surprise about their inability to articulate one.

But this is an example of why it sometimes helps, even in straight political reporting, to understand how policy works. Here’s the essential fact about health care policy, which in turn fundamentally shapes health care politics:

Obamacare looks the way it does because it has to.

Once again, for those who missed it: if you want to cover people with preexisting conditions, you must have community rating. If you want to have community rating without a death spiral — that is, if you want to keep an acceptable risk pool — you have to have an individual mandate. If you want to have an individual mandate, you have to have subsidies for lower-income Americans. And that’s Obamacare: a three-legged stool, with all three legs essential.

Republicans can’t offer an alternative because there isn’t one (aside, that is, from single-payer). Their plan, such as it was, was to wait for the plan to implode, so they would never be put on the spot; since that isn’t happening, Plan B is to bob and weave and avoid the question until the midterms. That’s all there is.