Matt Miller - The Archives
Yes, repeal health-care reform—on one condition
The Washington Post, January 19, 2011

Fine. I'm willing to repeal Obamacare. On one condition.

Republicans need to pass a law that the Congressional Budget Office certifies will cover the same number of uninsured as the Democratic health reform does—30 million. And it has to do it at lower cost.

If I were President Obama, this is what I would be saying this week. And in the State of the Union address next week. And every time the question comes up.

The logic is simple. If Republicans are serious, they have to accept that it's a national priority to make sure that every American has basic health coverage. Thirty million isn't enough, of course, because the ranks of the uninsured still hover around 50 million. But since Democrats could only muster the will to cover 30 million, that's all we can expect the GOP to match as a measure of seriousness. (Though I'd be happy to see them shame Democrats with a plan to cover more).

The reason Obama should frame the debate this way is that there is no chance the Republican House will pass such a bill. That's because the GOP does not view the presence of 50 million uninsured in a wealthy nation as an issue that needs to be addressed.

Why not? Largely because, as the late Daniel Patrick Moynihan once told me (channeling the Republican mind on the uninsured): "Those folks never vote for us and we have our priorities for the money."

Or, as the GOP lobbyist and former Minnesota congressman Vin Weber once explained to me: "Do we care? Yeah. But politics trumps that conviction."

Right now the "debate" over Obamacare is a symbolic ruse. Republicans are blaming health reform for all manner of ills even though the thing doesn't even get off the ground until 2014. If the president said, "Okay, John Boehner, you bet, now that you're in power, as soon as you pass a version that covers the same number of people for less, I'll be happy to put my approach aside and cut a deal," he'd remind Americans about the discussion Republicans refuse to have.

And for no good reason. After all, Obama made Romneycare—adapted from the conservative Heritage Foundation's (sensible) ideas—the centerpiece of his reform. He stiff-armed the left by leaving single payer off the table. In case no one got the message, Obama tossed the public option overboard in health care's legislative endgame.

Any reasonable Martian would thus conclude that Obamacare—that is, Romneycare for the rest of us—is a centrist scheme.

But embracing conservative ideas wasn't enough. Obama also backed them with real money—as he had to, to fund the subsidies required to help lower-income folks buy private insurance.

So, just as they did in 1994, Republicans said "no." When Obama met with Republican leaders in that hours-long televised health-care gabfest—a model of civility, by the way, if not consensus—the outer limit of GOP ambition was a plan that would cover 3 million of the uninsured.

I'm sorry, GOP, but 3 million is not serious.

Is Obamacare imperfect? You bet. I don't like the idea of micromanaging health plans via "medical loss ratios," for example. And if I were king, I'd have started with a cheaper approach that paired a funded health savings account for primary care with catastrophic coverage for every American (which capped annual costs at some fair percentage of income).

What's more, I still think the best model to emulate is mighty Singapore's, a savvy blend of private responsibility and public provision that leaves that nation with world-class outcomes at 4 percent of GDP (vs. our 17 percent). It's a breathtaking achievement that would give our overpaid medical industrial complex a heart attack.

But having said that, back in the universe in which we actually live, Obamacare was a historic first step. We need to mend it, not end it. Done right, its insurance exchanges will, over time, let us move past the inane relic of employer-based health care, a development that will be good for both business competitiveness and social justice.

To those who say we should get costs under control before extending coverage to the uninsured, I say: that's a perfectly reasonable argument . . . that only a well-insured person would make.

No doubt I'm guilty of what President Bush, in another context, called "the soft bigotry of low expectations." So to atone, here's my pledge: If the House passes a plan the CBO says will cover 30 million people, I'll not only eat my words; I'll eat the bill itself.