"There are a lot of other ideas out there, but what all conservatives can agree on is this: We think government should encourage personal responsibility, not replace it. We think prices are going up because people have too few choices, not because they have too many. And we think this problem is so urgent that, next year, we are going to unveil a plan to replace every word of Obamacare."
House Speaker Paul Ryan (R-Wis.) delivered a fairly long speech at the Library of Congress yesterday, fleshing out his vision for making America "confident again" through a far-right approach to governing. There wasn't anything particularly surprising about the remarks, and the Republican leader conceded his vision won't be implemented so long as President Obama is in office.
But there was one part of the speech that jumped out at me as noteworthy. On health care policy, the new Speaker said "the other side" -- presumably, Democrats -- opposes giving consumers choices, while Republicans want to encourage "insurance companies to compete for your business." It's an odd line of attack, since the Affordable Care Act's exchange marketplaces were specifically designed to invite insurers to compete for consumers' business. I'm not sure how he could have missed this detail.
Let's just skip the usual points about the efficacy of the ACA, the law's many successes, and the millions of Americans benefiting from its implementation. Suffice it to say, there's no credible reason to try -- or even want to try, really -- to replace "every word" of the Affordable Care Act.
What I found amusing, however, was Ryan's use of the word "urgent."
As the Republican leader sees it, there's no time to waste. The problems in the health care system are so great that the Speaker believes it's "urgent" for his party to present their conservative alternative -- nearly six years after the ACA was signed into law, nearly two years after the ACA was fully implemented. Now Ryan's serious about his party's replacement plan.
It's hard for even the most charitable observers not to laugh. On June 17, 2009, then-Rep. Roy Blunt (R-Mo.), a member of the House Republican leadership at the time, publicly declared that he was helping craft his party's alternative to the Affordable Care Act. "I guarantee you we will provide you with a bill," he said six and a half years ago.
The same week, then-Minority Whip Eric Cantor (R-Va.) told reporters that the official Republican version of "Obamacare" was just "weeks away."
The Huffington Post's Jeffrey Young has gotten quite a bit of mileage out of a joke, documenting all of the many, many times in recent years GOP officials have said they're finally ready to unveil their big health care solution, only to quietly fail every time.
We were told 2014 would be different. In April 2014, House Majority Whip Kevin McCarthy (R-Calif.) said his party's plan was nearly done, but was being delayed "at least a month." That was 20 months ago.
Then we were told 2015 would be different. Ryan was tasked with personally heading up a Republican "working group" that would finally put together the GOP's health care plan. Then-House Speaker John Boehner promised Fox News, "There will be an alternative, and you're going to get to see it."
That was 11 months ago.
As of yesterday, however, Ryan believes the issue is "so urgent" that we'll see the Republican "plan" in 2016. And who knows, maybe we will. I wouldn't bet on it, but anything's possible.
But revisiting a piece from February, I think we can safely assume that the House GOP alternative to "Obamacare" -- if it ever exists -- is going to be cover-your-eyes horrible. How can I know that? Because in order to actually reform the pre-2010 health care system -- "replacing every word" of the ACA -- policymakers have to commit to extensive public investments, expansive government regulation of the insurance industry, and a commitment to help struggling families receive guaranteed benefits.
In other words, to do reform right, Republicans would have to willingly take policy steps that are anathema to everything they believe about government. It's a safer bet they'll do reform wrong -- if they follow through at all -- and when the GOP alternative stands alongside "Obamacare" and consumers are allowed to compare, it won't be much of a contest.
This point is routinely lost on much of the chattering class, but Republicans don't actually like health care reform, which is why we've waited so many years to see a plan that still doesn't exist. GOP lawmakers didn't see the old system -- the bankruptcies, the uninsured rates, the deaths, Americans paying more for less -- as a problem requiring a solution, which is precisely why they haven't invested time and energy in writing a detailed reform blueprint.
Ryan seems to think this time will be different. Watch this space.