June 29, 2015


King v. Burwell: Two roads for Republicans (Stuart M. Butler, June 26, 2015, Brookings)

[R]epublicans have two alternatives after this ruling. They can choose to adopt "repeal" as simply an election battle cry for 2016, using the ACA as a "messaging" issue much as they did with the Clinton health plan after its collapse in 1994. Or they can engage in a more focused and deliberate strategy to change the direction of an established program, as they did successfully in accomplishing welfare reform in 1996. If Republicans choose the first alternative there may be some short-term election gains - although that is far from clear - but they will probably lose the long-term health reform war. The features of the ACA they so dislike would likely become entrenched. But if they choose the second alternative, and focus on the redesign of core elements of the law that could win bipartisan support, they could well change the structure and evolution of the ACA.

There's something in reform for everybody.  Universal coverage would not improve the physical health of the American people, but it would assuage peoples fears about what might happen to them and their families if illness struck and vindicate their desire not to have to seek charity in such cases.

Meanwhile, under cover of this universal health care the GOP could turn the program into a way of building personal capital universally.  Grant the coverage but do it in the form of HSAs, so that for the 60 years of life when most of us are healthy we're accumulating so much wealth that even the wasteful end-of-life spending we engage in won't deplete the accounts and we'll pass them on to our heirs.

Posted by at June 29, 2015 3:37 PM

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