Once More Unto the Breech

Ah yes, here we go again. Yet another attempt by the Republican Party to repeal and replace the Affordable Care Act. This time, as reported by Sarah Kliff in the Washington Post’s Health Reform Watch, Republican Sens. Richard Burr (N.C.), Tom Coburn (Okla.) and Orrin Hatch (Utah) last week released, “…what is arguably the most complete Obamacare replacement plan offered by their party to date.”

Entitled the Patient Choice, Affordability, Responsibility, and Empowerment Act (abbreviated as the “Patient CARE Act”) – it has a familiar ring to it, but read on – it is in certain enough ways similar to the Affordable Care Act that I was reminded of several works by Shakespeare. The first of course is the comedy, Much Ado About Nothing. The second is a quote from Hamlet: “the [Party of No] doth protest too much methinks.” And the third was a quote taken from Henry V, which I invoked as the title of this post.

Both Ms. Kliff’s piece as well as a Forbes’ magazine article written by Avik Roy provide excellent coverage in comparing and contrasting the two pieces of legislation, and I refer readers there for better explanation than I can offer here. To be sure there are marked differences in the way key concepts of healthcare reform are addressed in the Patient Care Act. But where the hypocrisy is laid bare is in noting the overarching points of likeness.

For starters, the Patient CARE Act is said by its own sponsors to have little impact on the federal deficit (i.e., budget neutrality) over a 10-year period following enactment. So much for conservative austerity.  It maintains the insurance restrictions on pre-existing conditions and benefits, though it shifts more risk back to the individual for maintaining coverage prior to such conditions. There is the concerted effort to expand coverage to poorer Americans, though less emphasis is placed on Medicaid while abandoning insurance exchanges.  It also recognizes the importance of attracting healthy individuals into insurance pools to thwart adverse selection.

The most significant difference has to do with financing. The Patient CARE Act would repeal most of the industry taxes on insurance companies, hospitals and medical device makers and replace that lost revenue by limiting the tax exclusion for employer-sponsored insurance to 65 percent of the average health insurance plan. This is a favored approach by many economists because of the regressive nature this historic tax preference, but given the impact it would have on millions of employed workers it’s not likely to gain much political traction even if Republicans do gain control of the Senate.

Despite key differences, however, what is interesting – or perhaps remarkable – to note is that the Affordable Care Act was used by Patient Care Act’s authors as the baseline upon which to develop healthcare policy. This is in marked contrast to claims of the Affordable Care Act being illegal, unconstitutional and/or socialistic. It almost appears as if there could have been a constructive and compromising effort for the two parties to work together in crafting the ACA, rather than the Republican Party being fixated in denying President Obama any modicum of political success.

For all of the cajoling, haranguing and caterwauling we’ve endured from the likes of Ted Cruz, Bobby Jindal, Marco Rubio and Rand Paul, this latest effort to appear politically constructive and contributing something meaningful to the healthcare policy debate comes off dreadfully sublime in comparison to the political rhetoric of the past several years. And its well placed timing only days before the State of the Union Address is of course par for the course in electoral hypocrisy.

When it’s all said and done I am left wondering whether we should retrospectively view the politial machinations and hijinks the Republican Party has wrought upon this country over the past several years as comedy or tragedy. Perhaps both. A number of Shakespeare’s best works after all were tragicomedies: Hamlet, Macbeth, Othello and King Lear. I only wish watching the Republican Party’s performance of political implosion would have been as entertaining.

Enjoy the SOTU Address! Could be some real fireworks in the great hall tonight.


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