Jonathan Cohn argues that most Republican healthcare plans would be more far disruptive than the ACA:
With Obamacare, a small number of people lose their current insurance but they end up with alternative, typically stronger coverage. Under the plans Republicans have endorsed, a larger number of people would lose their current insurance, as people migrated to a more volatile and less secure marketplace. Under Obamacare, the number of Americans without health insurance at all will come down, eventually by 30 or 40 million. Under most of the Republican plans, the number of Americans without insurance would rise.
Honest Republicans would justify their policies by arguing that Medicaid is a wasteful, inefficient program not worth keeping—and their changes, overall, would reduce health care spending while maximizing liberty. In other words, forcing people to give up their coverage is worth it. I don’t agree with those arguments, but they are honest. But they should stop pretending that it’s possible to address the problems of American health care without disrupting at least some people’s insurance arrangements—because, after all, they want to do the very same thing.
Chait thinks this is why Republicans have failed to propose a real Obamacare alternative:
Every iteration of an alternative conservative health-care proposal would impose far more disruption on the status quo than would Obamacare. Most conservative plans involve drastically curtailing the tax deduction for employer-based insurance. That would create cancellation notices for many times the number of people currently seeing them. Even the more modest plans to scale back Obama’s regulation of the individual market would run the GOP into a political minefield. Which regulations do they want to strip away? Discrimination against people with preexisting conditions? Discrimination against potentially pregnant women? Mental-health parity? Every single one of those changes creates millions of angry potential victims.
This is exactly why the actual Republican Party health-care plan is not repeal and replace, but repeal and cackle. Republicans are on strong ground exploiting fear of change. They have understood perfectly well that they must avoid having to defend a different set of changes to the status quo. They have kept their various replace ideas safely to the side for exactly that reason.
Beutler piles on:
[S]mart conservatives — which is to say, policy wonks without much cachet on Capitol Hill — would replace all insurance with subsidized catastrophic coverage and tax-preferred health savings accounts. Nobody with private insurance or Medicaid would get to keep what they have, no matter how much they like it.
Reihan objects:
To be sure, there are some people who think that government policy should lean against comprehensive insurance. David Goldhill, author of Catastrophic Care, favors something like single-payer catastrophic coverage. Brad DeLong has floated the idea as well. The conservatives I think Beutler has in mind certainly like the idea of catastrophic insurance. It’s just that they have no problem with allowing people to buy comprehensive insurance if that’s what they’d like to do with their money, and they recognize that low-income and disabled individuals will need larger subsidies than other people. …
One can definitely imagine alternatives to Obamacare that would be more disruptive than Obamacare. If consumers were banned from purchasing comprehensive health insurance, for example, there would definitely be a lot of disruption. But by and large, “reform conservatives” favor more modest measures that are designed to ease the transition to a more sustainable system.
The Dish 