JONATHAN COHN MARCH 3, 2011
Today the Wall Street Journal editorial page joins the chorus of conservatives trashing President Obama's Monday announcement about the Affordable Care Act. Obama said he was offering the states greater flexibility, by allowing them to opt out of the Act' under certain circumstances. But the flexibility he'd afford is just a "mirage," according to the Journal. States "would still need to find other mechanisms to achieve the same liberal priorities."
Well, yes, that's true. But that's because the "liberal priorities" are to provide everybody with decent, affordable health insurance. This is the point Steve Benen, Ezra Klein, and others (including me) have made in the last past few days: Conservatives don't have better ideas for achieving these goals.
The Journal, for example, suggests states should have freedom to introduce "a straight tax deduction or credit to purchase individual coverage." Well, states already have that freedom, under the Affordable Care Act's waiver process, and if Obama gets his way they'd have that freedom a few years earlier. (He has endorsed the Wyden-Brown bill, which would start the waiver process in 2014, rather than 2017, as the law currently does.) Of course, there's a catch: They'd have to construct plans that, like the Affordable Care Act, provided basic insurance to 95 percent of legal residents, without increasing the deficit.
That's possible, I suspect. But it would require a lot of regulation and, most likely, even more government outlays than the Affordable Care Act mandates. Also, such schemes would probably disrupt a lot existing insurance arrangements. That's ok with me but, I'm willing to bet, it's not ok with the Journal. (Or maybe it is, although then I'd like to know why they're so upset about the far more minimal disruptions that will come with the Affordable Care Act.)
Similarly, the Journal complains that the Affordable Care Act's waiver process precludes high-deductible or value-based insurance plans, which make individuals more responsible for their own health care bills. (I.e., they would object to Obama's definition of "basic insurance.") Again, I don't think this is true. To repeat what I wrote a few months ago, when a more thoughtful conservative, Ross Douthat, made the same criticism:
Look closely at the standards for coverage in the insurance exchanges: The minimal, or bronze, insurance option allows out-of-pocket spending of up to $12,500 for a family of four. The actuarial value is 60 percent, which means, very roughly, that the plan only covers about 60 percent of the average person's medical bills. Those are some pretty high deductibles! I haven't made the apples-to-apples comparison and I don't know anybody who has, but I'm pretty sure the overall exposure is comparable to what you get in a [plan that goes with a] Health Savings Account, which is the model ... conservatives generally say they want.
Mind you, I'm not exactly happy about this: I think the out-of-pocket protections should be stronger. But precisely because this aspect of the Affordable Care Act makes me uncomfortable, I'd expect conservatives ... to take some comfort in it--more, at least, than they do now.
Of course, if you want to implement such a plan in a way that still makes medical care affordable to the poor and lower-middle-class, particularly those with serious medical problems, you actually have to spend a lot of money on subsidies. Most likely, you'd end up with as many if not more government outlays than the Affordable Care Act requires.
So don't let the Journal editors' sneer about "liberal priorities" distract you. What they really find objectionable is the pursuit of universal coverage. Whether that reflects principled opposition to the means or relative ambivalence about the ends, I can't say, although I suppose the two aren't mutually exclusive.