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Why there's no Republican health care plan

GOP lawmakers like to pretend they have an Obamacare alternative. There's a reason they've struggled for years to come up with a credible policy rival.
A tree photographed on a snow-covered field during sunrise near Memmingen, southern Germany, Tuesday Dec. 20, 2011. (AP Photo/dapd/Sebastian Widmann)
Where's the Republican alternative to the Affordable Care Act? The question is generally best suited for milk cartons -- it's pretty clear GOP officials would love to "repeal" the federal health care law, but we've been waiting for years to know what they'd "replace" it with.
This observation is an ongoing point of annoyance for the right, which is quick to argue that a variety of Republicans have presented reform plans of their own. Americans for Tax Reform's Grover Norquist and Patrick Gleason push the argument in a new Politico piece, and Sen. Pat Toomey (R-Pa.) made a related case in the Republicans' official weekly address over the weekend.

"There are common-sense, bipartisan solutions to our health care problems that don't require ObamaCare's wholesale government take-over of the system," Toomey said. "Now, in a nutshell, we can make insurance more accessible, more affordable, and more responsive to individuals and families. And put patients and their doctors in charge of health care decisions, instead of politicians and government bureaucrats." [...] Toomey did not mention a specific proposal, but he voiced support for allowing people to transfer insurance from job to job and purchase it across state lines.

And just like that, we're reminded all over again why Republicans love to attack what exists, but struggle to craft a credible alternative of their own. Toomey still doesn't quite understand that the Affordable Care Act is not a "wholesale government take-over" of the health care system, and more importantly, can't get past the "nutshell" phase of the GOP's rival policy.
In fairness, it's worth emphasizing that Republicans did present something resembling a health care plan in 2009. Following up on our previous coverage, GOP officials missed a series of self-imposed deadlines in 2009, but eventually threw together a half-hearted joke -- the GOP "policy" largely ignored the uninsured, did nothing for those with pre-existing conditions, and offered nothing for those worried about losing coverage when it's needed most.
As Matt Yglesias noted at the time, the Republican approach to reform sought to create a system that “works better for people who don’t need health care services, and much worse for people who actually are sick or who become sick in the future. It’s basically a health un-insurance policy.” And as ThinkProgress added, the CBO crunched the numbers and found that the Republican alternative would leave “about 52 million” Americans without access to basic medical care.
Pressed for some kind of alternative to Obamacare, this was the best congressional Republicans could do.
Since then, GOP lawmakers have periodically stepped up with alternatives, all of which looked pretty similar. Indeed, a few months ago, when the Republican Study Committee said they'd finally put together an "Obamacare" rival, Ed Kilgore predicted before its unveiling that the policy would feature high-risk pools, interstate sales, tax credits, tort reform, and entitlement reform. A couple of hours later, the RSC unveiled its proposal and it was ... exactly what Kilgore predicted it would be.
Months later, Toomey used his party's weekly address to reiterate support for the same cliches.
The result is a stunted debate. We don't have two competing approaches to solving a problem that has plagued the nation for decades; we have one party with a solution and another party that hates the solution but has no serious alternative. And this isn't likely to change anytime soon -- NBC's First Read reported two weeks ago, "House Republicans wouldn't commit Tuesday to offering their own formal alternative to the Affordable Care Act, instead vaguely describing their preference for a 'patient-driven health care system.'"
As for why Republicans have no rival plan, as we discussed in September, there's no great mystery. Every credible, effective solution requires some combination of regulating the private insurance market and investing in broader coverage for consumers. There's just no way around that, and as a result, GOP officials are left with an ideological hurdle they simply cannot clear.
And so Republicans spin their wheels, condemning a policy that they used to like -- remember, the basic ACA blueprint was a conservative approach to health care reform -- while pretending to have an alternative they can't identify in earnest.