Here's Why Republicans Will Never Reform Health Care

Philip Klein writes that Obamacare will get blamed for all sorts of problems in the American health care system, even problems that would have existed with or without the law:

Given that the law was sold as a way to fix a broken health care system, rightly or wrongly, the law is going to be blamed for any persistent problems. It's impossible for Americans to sort out whether a given change took place as a result of the law or whether it would have happened anyway. If they don't like a change to their health care situation that occurred after a giant new law went into effect, they're going to blame that giant new law.

If I were a vulnerable Democrat incumbent in 2014, I wouldn't want to pin my re-election hopes on being able to convince angry voters that changes that they hate would have happened with or without the health care law. "Correlation doesn't equal causation" is not exactly a winning campaign slogan.

Klein is right. And his analysis explains why Republicans have had the same health policy strategy for 20 years: Nominally favoring big fixes to our health care system but not enacting them.

Many Republicans say they favor converting the tax exclusion for employer-provided health insurance into a tax credit. This would help some people with moderate incomes afford to buy health insurance. It would also increase the cost of health care for many people, particularly those with high incomes or high-cost health plans. That would upset a lot of people.

Many Republicans say they want to equalize the tax treatment of employer-provided health insurance and individually-purchased health insurance. This would lead some employers to drop coverage, which would upset a lot of people.

Many conservatives say they favor allowing health insurance plans to be sold across state lines. That would lead health insurers to exit many states' insurance markets, clustering in those states that have insurer-favorable regulations, much in the way credit card issuance is now concentrated in South Dakota, Nevada and Delaware. That would lead to the cancellation of a lot of existing health insurance plans in the individual market, which would upset a lot of people.

Those problems would cluster on top of problems that arise all the time in health insurance markets, absent any public policy change: Rising prices, doctors changing what insurances they accept, employers changing their benefit offerings, whatever. Conservative health reformers would take the blame for all the problems their reforms created, and many problems they didn't, just as has happened to liberals with Obamacare.

So it's no surprise Republicans haven't enacted any of the big reforms they like to talk about. The only reforms they've been able to implement are ones that hand out new benefits without creating any losers: A new prescription drug benefit in Medicare and expanded tax advantages for health spending, such as Health Savings Accounts.

These policies haven't addressed the problems of high costs or of lack of insurance for many people under age 65. But they also haven't exposed Republicans to attack for causing people's health plans to change.

Liberals chose to reform health policy despite the political risks, because their political coalition includes the people who are most extensively screwed by the health policy status quo. Conservatives have decided that cynicism is a better political strategy, for the reasons Klein inadvertently lays out. They're probably right on the politics, but that's nothing to be proud of.