Now that House Republicans have followed through on their promise to hold a meaningless vote on repealing the Affordable Care Act, they'll be commencing a complex effort on health care, in which both the ACA's shortcomings and the GOP's alternative ideas will be presented to the public in high-profile events, so the American people can see the wisdom of Republican solutions. Right?
Wrong. As we know, the political problem that repealing the ACA presents for Republicans is that people like the actual things the law does, and once you've gotten past the symbolic repeal vote, if you want to start dismantling it, you're going to be attacking just those things people like. So what are we going to see? A hearing here and there, some gamesmanship when the budget is written, but on the whole, the repeal effort from this point forward will look rather half-hearted.
It's not just the political problem that repeal represents. Just as important in the absence of the "replace" part of "repeal and replace" is that as a group, Republicans don't really care much about health care. That's why there is, and has long been, a "wonk gap" on this issue. Republicans will gear up to fight against a Democratic reform effort, but when that's not going on, it just isn't high on their list of priorities. They're more interested in tax policy, and defense policy, and some other things. In contrast, health care is something Democrats care a lot about, and have thought a lot about. As a result, their policy ideas, while not always politically pithy, tend to be serious, nuanced attempts to grapple with the complexities of the issue. Republican health-care ideas tend to be of the "If we do this simple thing, all the problems will be solved" variety. Take away people's ability to sue for malpractice, and costs will plummet! Health savings accounts are the answer! People who actually know a lot about health care understand that these "solutions" don't come within a hundred miles of solving the system's problems.
There are similar wonk gaps that run the other way -- for instance, conservatives have more think-tank scholars mining the intricacies of military policy than progressives do. To spend years working on an issue, you have to care deeply about it, and be fascinated by it. That just doesn't describe Republicans when it comes to health care. So now that they've gotten over the hump of the repeal vote and appeased their angry new Tea Party members, and now that the politics of the issue become more complicated, they're going to quickly lose interest. If you're waiting for that Republican health-care plan to "replace" the ACA, you'll be waiting a long time.
-- Paul Waldman
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