Senator Rand Paul is skeptical. He thinks something’s fishy about this whole “repeal and replace” thing that Republican congressional leaders have planned for Obamacare, which is basically the name for the multi-trillion-dollar U.S. health-care system and the complex web of insurance rules, subsidies and taxes that enables millions of Americans to obtain health insurance and, as a result, care.
After Republicans were handed control of Washington in November, their longtime insistence on “repeal and replace” began morphing into “repeal and delay.” Politically, Republicans find this easy to justify. First, they are eager to avoid blame for throwing 20 million Americans off of their health insurance, causing some to forgo vital care and, as a consequence, expire prematurely and, worst case, publicly. Second, they have never actually had a replacement policy, do not now have a replacement policy, and, given ideological and cost constraints, are highly unlikely ever to have a replacement policy.
The reason for this is not complicated. Both insurance and health-care services cost money. Poor people don’t have money. And Republicans don’t want the people with money to subsidize the people without it (although they are not always opposed to a reverse transaction).
Paul sees an opportunity for political arbitrage here. He’s hardly alone in speculating that whatever Republicans end up with could be a cosmic mess. Most likely, they will strip key funding for Obamacare while trying to maintain as much as possible of Obamacare’s services. The result will be compromised services combined with large and unsustainable contributions to federal deficits.
Instead, Paul suggests in an op-ed essay, “As we repeal Obamacare, we would be wise to vote on its replacement at the same time”:
What should we replace Obamacare with? Perhaps we should try freedom:
The freedom to choose inexpensive insurance free of government dictates.
The freedom to save unlimited amounts in a health savings account.
The freedom to buy insurance across state lines.
The freedom for all individuals to join together in voluntary associations to gain the leverage of being part of a large insurance pool.
Even casual readers of political or health-care news will find these ideas numbingly familiar. They are the rusty bolts that have long held Republican boilerplate together. Together, they would deliver loads of freedom to people who, under the circumstances, might prefer to see a doctor.
Paul, an ophthalmologist, knows that. His home state of Kentucky has been one of the great beneficiaries of Obamacare’s expansion of care to the poor and working class. According to the U.S. Department of Health and Human Services, 151,000 additional Kentuckians have Medicaid insurance due to Obamacare, resulting in 180 “avoided deaths” in the state annually. More than 74,000 others obtained coverage through Obamacare’s individual market. And the 2.3 million in the state who have employer-based insurance have benefited from rules changes that have made their insurance coverage more robust and more secure, such as requiring coverage for pre-existing conditions and an end to annual and lifetime limits.
Even if all Republican complaints about Obamacare were accurate — and they’re not — those would still be real people with real insurance coverage that enables them to gain access to real health care. Freedom is a great concept. But it will leave some of those people sicker and others dead.
Instead of partaking in the current charade that Republicans can repeal Obamacare and eventually, somehow, some way, come up with a replacement that doesn’t cost a lot or literally kill a couple hundred of his neighbors every year, Paul is sticking to the old charade: that repealing Obamacare and replacing it immediately with GOP talking points about freedom will solve the problem.
In effect, Paul is calculating that his transparent nonsense will look pretty good compared with whatever his Republican colleagues actually come up with. Then, in 2024 (or 2020), Paul will campaign for the GOP presidential nomination as a truth-teller and conservative stalwart who told everyone that freedom was the antidote to Obamacare. If only they’d listened.
Sure, his stance isn’t brave. It’s just another cheap gimmick in a long line of same. But in the context of the bankruptcy that is Republican health-care politics, it’s not a bad play.